Petrus G Cronje

Individual provider Active NPI Geriatric Physical Therapist · Port Orange, FL

NPI 1104073444 · NPPES record last updated Aug 19, 2008

Key facts

NPI
1104073444
Entity type
Individual (NPI type 1)
Primary specialty
Geriatric Physical Therapist 2251G0304X
License
PT14506 (FL)
Practice address
6513 Shahab LN
Port Orange, FL 32128-6073
Phone
(386) 756-4092
NPI assigned
Aug 19, 2008
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Physical Therapy and Associates LTD Co Geriatrics Past
since Jan 1, 2001
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X PT14506 FL Yes

Addresses

Primary practice location

6513 Shahab LN
Port Orange, FL 32128-6073

Mailing address

6513 Shahab LN
Port Orange, FL 32128-6073
Phone (386) 756-4092

Other providers in Port Orange, FL

All providers in Port Orange, FL · Geriatric Physical Therapist in Florida

Sources for this page

Verify at the official NPI Registry.