Provider Demographics
NPI:1033720354
Name:ADVANCE CARE PHYSICAL THERAPY PC INC
Entity Type:Organization
Organization Name:ADVANCE CARE PHYSICAL THERAPY PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-255-8255
Mailing Address - Street 1:4968 NW 106TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2713
Mailing Address - Country:US
Mailing Address - Phone:347-255-8255
Mailing Address - Fax:718-554-3034
Practice Address - Street 1:4968 NW 106TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2713
Practice Address - Country:US
Practice Address - Phone:347-255-8255
Practice Address - Fax:718-554-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02924418Medicaid