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Organization
ON THE GO, HOME PHYSICAL THERAPY SERVICES, LLC
Active
Organization
ON THE GO, HOME PHYSICAL THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IRINA DETATA PT (PHYSICAL THERAPIST)
(954) 445-4745
Entity
Organization
Contact information
Practice address
4331 SW 73RD TER, DAVIE, FL 33314-3030
(954) 445-4737
Mailing address
PO BOX 292711, DAVIE, FL 33329-2711
(954) 445-4737
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
PT20047
FL
Other
Enumeration date
12/01/2016
Last updated
12/01/2016
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