Provider Demographics
NPI:1992136857
Name:ADVANCE THERAPY & REHAB CENTER INC
Entity type:Organization
Organization Name:ADVANCE THERAPY & REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-582-1593
Mailing Address - Street 1:221 MAJORCA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4434
Mailing Address - Country:US
Mailing Address - Phone:305-582-1593
Mailing Address - Fax:786-228-4941
Practice Address - Street 1:221 MAJORCA AVE APT 4
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4434
Practice Address - Country:US
Practice Address - Phone:305-582-1593
Practice Address - Fax:786-228-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21975 HCC939261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation