Provider Demographics
NPI:1285794313
Name:LIFE QUALITY REHABILITATIVE SERVICES INC.
Entity type:Organization
Organization Name:LIFE QUALITY REHABILITATIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-869-0867
Mailing Address - Street 1:7025 BERACASA WAY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3443
Mailing Address - Country:US
Mailing Address - Phone:561-869-0867
Mailing Address - Fax:561-869-0868
Practice Address - Street 1:7025 BERACASA WAY
Practice Address - Street 2:SUITE #101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3443
Practice Address - Country:US
Practice Address - Phone:561-869-0867
Practice Address - Fax:561-869-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3951Medicare UPIN