Provider Demographics
NPI:1447492863
Name:FLORIDA THERAPY CENTER OF PALM BAY, LLC
Entity type:Organization
Organization Name:FLORIDA THERAPY CENTER OF PALM BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRONMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:321-726-4150
Mailing Address - Street 1:4711 BABCOCK ST NE STE 6
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2805
Mailing Address - Country:US
Mailing Address - Phone:321-726-4152
Mailing Address - Fax:
Practice Address - Street 1:4711 BABCOCK ST NE STE 6
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2805
Practice Address - Country:US
Practice Address - Phone:321-726-4152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty