Provider Demographics
NPI:1992993596
Name:PATIENTS FIRST PHYSICAL THERAPY
Entity type:Organization
Organization Name:PATIENTS FIRST PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:HOFF
Authorized Official - Last Name:GORTEMOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:850-526-4766
Mailing Address - Street 1:4966 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6814
Mailing Address - Country:US
Mailing Address - Phone:850-526-4766
Mailing Address - Fax:850-526-4866
Practice Address - Street 1:4966 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6814
Practice Address - Country:US
Practice Address - Phone:850-526-4766
Practice Address - Fax:850-526-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886499300Medicaid
FLK3548Medicare PIN