Organization
DIAMOND HEART INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ATEF FARAH MITRY PHYSICAL THERAPIST (PRESIDENT)
(386) 767-0557
Entity
Organization
Contact information
Practice address
3959 S NOVA RD STE 1, PORT ORANGE, FL 32127-4900
(386) 767-0557
(386) 767-3251
Mailing address
3959 S NOVA RD STE 1, PORT ORANGE, FL 32127-4900
(386) 767-0557
(386) 767-3251
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 10588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB2957
MEDICARE RAILROAD
FL
Enumeration date
03/12/2008
Last updated
03/12/2008
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