NPIMap

Organization Active NPI

Physical Therapy at Home Inc

  • Physical Therapist
  • Venice, FL
National Provider Identifier
1346505559
Registry record updated Oct 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT12658 Issued in FL
Legal business name
PHYSICAL THERAPY AT HOME INC
Practice address
1121 Jacaranda Blvd
Venice, FL 34292-4586
Phone
(941) 206-5200
Fax
(941) 504-6842
NPI assigned
Jul 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2013

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

Authorized official

Name
Gomaa Ramadam Ibrahim Ali, PT
Title
Owner
Phone
(941) 206-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT12658 FL Primary

Addresses

Primary practice location

1121 Jacaranda Blvd
Venice, FL 34292-4586

Mailing address

611 May Apple Way
Venice, FL 34293-7278
Phone (941) 206-5200

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382918400000",
    "number": "1346505559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 MAY APPLE WAY",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342937278",
            "telephone_number": "941-206-5200",
            "fax_number": "941-504-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924586",
            "telephone_number": "941-206-5200",
            "fax_number": "941-504-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY AT HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2013-10-28",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM ALI",
        "authorized_official_first_name": "GOMAA",
        "authorized_official_middle_name": "RAMADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-206-5200",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT12658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.