Organization
BONIFAY PHYSICAL THERAPY
Active
Parent organization
CHIPLEY PHYSICAL THERAPY
Other names
Bonifay Physical Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHIPLEY PHYSICAL THERAPY
Authorized official
MR. RUBEN ALONZO LAUREL (PRESIDENT)
(850) 638-3387
Entity
Organization
Contact information
Practice address
1812 S WAUKESHA ST, BONIFAY, FL 32425-3100
(850) 547-4646
(850) 547-4766
Mailing address
1812 S WAUKESHA ST, BONIFAY, FL 32425-3100
(850) 547-4646
(850) 547-4766
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT14591
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y921V
BCBS FL PROVIDER #
FL
Enumeration date
02/09/2007
Last updated
05/16/2019
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