Organization
FLORIDA MOVEMENT THERAPY CENTER-BOCA RATON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI GRAY PT (VICE PRESIDENT)
(561) 883-7800
Entity
Organization
Contact information
Practice address
21065 POWERLINE RD, SUITE A2, BOCA RATON, FL 33433-2313
(561) 883-7800
(561) 883-7801
Mailing address
21065 POWERLINE RD, SUITE A2, BOCA RATON, FL 33433-2313
(561) 883-7800
(561) 883-7801
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT3436
FL
225XN1300X
Neurorehabilitation Occupational Therapist
OT9734
FL
235Z00000X
Speech-Language Pathologist
SA5535
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GL290A
MEDICARE PTAN
—
Enumeration date
06/07/2012
Last updated
07/07/2016
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