Provider Demographics
NPI:1902300379
Name:PINECREST PT- DAVIE L.L.C.
Entity Type:Organization
Organization Name:PINECREST PT- DAVIE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RANI
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:305-722-0568
Mailing Address - Street 1:PO BOX 331922
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-1922
Mailing Address - Country:US
Mailing Address - Phone:305-722-0568
Mailing Address - Fax:
Practice Address - Street 1:4900 S UNIVERSITY DR STE 106
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3809
Practice Address - Country:US
Practice Address - Phone:305-722-0568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18067261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy