NPIMap

Organization Active NPI

Florida Movement Therapy Center-Boynton Beach Inc

  • Physical Therapist
  • Boynton Beach, FL
National Provider Identifier
1013105196
Registry record updated Oct 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 3436 Issued in FL
Legal business name
FLORIDA MOVEMENT THERAPY CENTER-BOYNTON BEACH INC
Practice address
12040 S Jog Rd
Suite 8
Boynton Beach, FL 33437-4164
Phone
(561) 733-5083
NPI assigned
Oct 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Edward Patrick Gray, OTR/L-PTA
Title
President
Phone
(561) 733-5083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT 3436 FL Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT 9734 FL

Addresses

Primary practice location

12040 S Jog Rd
Suite 8
Boynton Beach, FL 33437-4164

Mailing address

12040 S Jog Rd
Suite #8
Boynton Beach, FL 33437-4164
Phone (561) 733-5083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080213000029 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1759464837 Receives reassigned benefits from 46 practitioners
Practice locations: Boynton Beach, FL

National Provider Directory

National Provider Directory

Locations

12040 S Jog Rd
Ste 7
Boynton Beach, FL 33437
Phone (561) 733-5083

430 NE 5th Ave
Ste A
Delray Beach, FL 33483
Phone (561) 866-7947

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1013105196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 S JOG RD",
            "address_2": "SUITE #8",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334374164",
            "telephone_number": "561-733-5083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 S JOG RD",
            "address_2": "SUITE 8",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334374164",
            "telephone_number": "561-733-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MOVEMENT THERAPY CENTER-BOYNTON BEACH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-14",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-733-5083",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR/L-PTA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 3436",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT 9734",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.