| Physical Therapy Now Sunrise | |
|
4490 N University Dr Lauderhill FL 33351-4513 | |
| (754) 701-7274 | |
| (954) 453-6065 |
| Full Name | Physical Therapy Now Sunrise |
|---|---|
| Speciality | Clinic/Center |
| Location | 4490 N University Dr, Lauderhill, Florida |
| Authorized Official Name and Position | Donna Lea Fonda (CREDENTIALING DIRECTOR) |
| Authorized Official Contact | 3055171219 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physical Therapy Now Sunrise 4490 N University Dr Lauderhill FL 33351-4513 Ph: (754) 701-7274 | Physical Therapy Now Sunrise 4490 N University Dr Lauderhill FL 33351-4513 Ph: (754) 701-7274 |
| NPI Number | 1194365841 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 04/01/2021 |
| Certification Date | 04/01/2021 |
| Medicare PECOS PAC ID | 8022433374 |
|---|---|
| Medicare Enrollment ID | O20200803002381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194365841 | NPI | - | NPPES |
| PT33616 | Other | FL | PT LICENSE |
| CH8692 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| 111N00000X | Chiropractor | (NU) | Secondary |
| 225100000X | Physical Therapist | (NU) | Secondary |
| Provider Name | Richard a Henry |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1285741744 PECOS PAC ID: 3678553484 Enrollment ID: I20040723000282 |
| Provider Name | Raymond E Masse |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255418711 PECOS PAC ID: 0143311944 Enrollment ID: I20070808000677 |
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