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Organization
PHYSICAL THERAPY AT HOME INC
Active
Organization
PHYSICAL THERAPY AT HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOMAA RAMADAM IBRAHIM ALI PT (OWNER)
(941) 206-5200
Entity
Organization
Contact information
Practice address
1121 JACARANDA BLVD, VENICE, FL 34292-4586
(941) 206-5200
(941) 504-6842
Mailing address
611 MAY APPLE WAY, VENICE, FL 34293-7278
(941) 206-5200
(941) 504-6842
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT12658
FL
Other
Enumeration date
07/13/2012
Last updated
10/28/2013
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