Provider Demographics
NPI:1083889059
Name:PHYSICAL THERAPY AT DORAL, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AT DORAL, LLC
Other - Org Name:INTEGRA REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-537-7227
Mailing Address - Street 1:8725 NW 18TH TERRACE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2697
Mailing Address - Country:US
Mailing Address - Phone:305-537-7227
Mailing Address - Fax:305-537-7224
Practice Address - Street 1:8725 NW 18TH TERRACE
Practice Address - Street 2:SUITE 211
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2697
Practice Address - Country:US
Practice Address - Phone:305-537-7227
Practice Address - Fax:305-537-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X, 225X00000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZC285AMedicare UPIN