Provider Demographics
NPI:1124225958
Name:ULTRA THERAPY CARE CENTER, CORP.
Entity Type:Organization
Organization Name:ULTRA THERAPY CARE CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:NALDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-507-4218
Mailing Address - Street 1:5854 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2603
Mailing Address - Country:US
Mailing Address - Phone:786-507-4218
Mailing Address - Fax:
Practice Address - Street 1:5854 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2603
Practice Address - Country:US
Practice Address - Phone:786-507-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6057160111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty