Provider Demographics
NPI:1194069773
Name:VESTBULAR REHABILITATION AND DIZZINESS CENTER INC
Entity type:Organization
Organization Name:VESTBULAR REHABILITATION AND DIZZINESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT MSHSA
Authorized Official - Phone:561-236-4523
Mailing Address - Street 1:6508 BLUE BAY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7219
Mailing Address - Country:US
Mailing Address - Phone:561-236-4523
Mailing Address - Fax:561-436-9146
Practice Address - Street 1:2515 S STATE ROAD 7
Practice Address - Street 2:SUITE 210
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9334
Practice Address - Country:US
Practice Address - Phone:561-236-4523
Practice Address - Fax:561-642-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT84672251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12449295OtherCAQH