NPIMap

Organization Active NPI

Dr. Physio Therapy & Wellness

  • Physical Therapy Clinic/Center
  • Fort Lauderdale, FL
National Provider Identifier
1154802148
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
28107 Issued in FL
Legal business name
DR. PHYSIO THERAPY & WELLNESS
Practice address
4324 N Federal Hwy
Fort Lauderdale, FL 33308-5208
Phone
(954) 369-5787
Fax
(954) 206-7733
NPI assigned
Aug 27, 2018
Last updated
Jun 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Authorized official

Name
Lenisson M Carneiro, PT, DPTNPI 1811236169
Title
Physical Therapist/Owner
Phone
(954) 245-4798

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 28107 FL Primary

Addresses

Primary practice location

4324 N Federal Hwy
Fort Lauderdale, FL 33308-5208

Mailing address

4324 N Federal Hwy
Fort Lauderdale, FL 33308-5208
Phone (954) 369-5787

Other practice location 1

4318 N Federal Hwy
Fort Lauderdale, FL 33308-5208
Phone (954) 369-5787

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190418000856 FL Part B Supplier - Clinic/Group Practice 2365783420 Receives reassigned benefits from 13 practitioners
Practice locations: Fort Lauderdale, FL; Delray Beach, FL

National Provider Directory

National Provider Directory
Tax ID family
Dr Physio Therapy Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4318 N Federal Hwy
Fort Lauderdale, FL 33308
Phone (954) 369-5787

4324 N Federal Hwy
Ft Lauderdale, FL 33308
Phone (954) 369-5787

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1154802148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4324 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085208",
            "telephone_number": "954-369-5787",
            "fax_number": "954-206-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4324 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085208",
            "telephone_number": "954-369-5787",
            "fax_number": "954-206-7733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4318 N Federal Hwy",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333085208",
            "country_code": "US",
            "telephone_number": "954-369-5787",
            "fax_number": "954-206-7733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR. PHYSIO THERAPY & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-27",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "CARNEIRO",
        "authorized_official_first_name": "LENISSON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "954-245-4798",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "28107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.