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
State | License ID | Taxonomies |
---|---|---|
FL | PT28158 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |