Provider Demographics
NPI:1104032432
Name:ADVANCE REHAB CLINIC, INC
Entity type:Organization
Organization Name:ADVANCE REHAB CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVES
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAJEUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-401-3430
Mailing Address - Street 1:5340 RECKER HWY
Mailing Address - Street 2:BLDG. 2 STE. A
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1256
Mailing Address - Country:US
Mailing Address - Phone:863-401-3430
Mailing Address - Fax:863-401-3465
Practice Address - Street 1:5340 RECKER HWY
Practice Address - Street 2:BLDG. 2 STE. A
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1256
Practice Address - Country:US
Practice Address - Phone:863-401-3430
Practice Address - Fax:863-401-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty