Provider Demographics
NPI:1164937173
Name:PELVICORE REHAB
Entity Type:Organization
Organization Name:PELVICORE REHAB
Other - Org Name:PELVICORE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINOGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-295-1631
Mailing Address - Street 1:7376 WEXFORD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4158
Mailing Address - Country:US
Mailing Address - Phone:201-704-4411
Mailing Address - Fax:561-409-4972
Practice Address - Street 1:7376 WEXFORD TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4158
Practice Address - Country:US
Practice Address - Phone:201-704-4411
Practice Address - Fax:561-409-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28158261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy