Basic Information
| Provider Information | |||||||||
| NPI: | 1396997904 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSAL PHYSICAL MEDICINE ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12596 NW 67TH DR | ||||||||
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| City: | PARKLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330761961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543407041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 JOHNSON ST | ||||||||
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| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330215421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | INOCENTES | ||||||||
| AuthorizedOfficialFirstName: | ARIEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9543407041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.