Provider Demographics
NPI:1093141160
Name:PROFESSIONAL THERAPEUTIC CARE CENTER,LLC
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPEUTIC CARE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:407-629-4325
Mailing Address - Street 1:4947 N PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7116
Mailing Address - Country:US
Mailing Address - Phone:407-629-4325
Mailing Address - Fax:
Practice Address - Street 1:4947 N PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7116
Practice Address - Country:US
Practice Address - Phone:407-629-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3229261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service