Provider Demographics
NPI:1215473384
Name:FELICE CENTER FOR PEDIATRIC REHABILITATION - MAITLAND
Entity type:Organization
Organization Name:FELICE CENTER FOR PEDIATRIC REHABILITATION - MAITLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-972-3960
Mailing Address - Street 1:7203 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7101
Mailing Address - Country:US
Mailing Address - Phone:321-972-3960
Mailing Address - Fax:321-972-3960
Practice Address - Street 1:331 N MAITLAND AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4762
Practice Address - Country:US
Practice Address - Phone:321-972-3960
Practice Address - Fax:321-972-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004799200Medicaid