Organization
FUNDAMENTAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIEL NAGLER MSPT (OWNER)
(954) 648-7819
Entity
Organization
Contact information
Practice address
4106 N 48TH AVE, HOLLYWOOD, FL 33021-1735
(954) 648-7819
Mailing address
4106 N 48TH AVE, HOLLYWOOD, FL 33021-1735
(954) 648-7819
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000288300
—
FL
01
—
PT20744
PHYSICAL THERAPY LICENSE
FL
Enumeration date
10/21/2020
Last updated
10/21/2020
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