Provider Demographics
NPI:1396795324
Name:ADVANCED THERAPY AND REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED THERAPY AND REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:EULALIO
Authorized Official - Last Name:LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-639-9500
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:461
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:305-639-9500
Mailing Address - Fax:305-639-3377
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:461
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:305-639-9500
Practice Address - Fax:305-639-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27900Medicare UPIN