Provider Demographics
NPI:1629071212
Name:SOUTH PALM PHYSICAL THERAPY SERVICES INC
Entity type:Organization
Organization Name:SOUTH PALM PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOVARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-376-8935
Mailing Address - Street 1:6642 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2016
Mailing Address - Country:US
Mailing Address - Phone:561-376-8935
Mailing Address - Fax:561-241-7763
Practice Address - Street 1:6642 NW 25TH CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2016
Practice Address - Country:US
Practice Address - Phone:561-376-8935
Practice Address - Fax:561-241-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1395AMedicare ID - Type Unspecified