Provider Demographics
NPI:1245582410
Name:PHYSICARE, LLC
Entity Type:Organization
Organization Name:PHYSICARE, LLC
Other - Org Name:PHYSICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILANES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:305-456-0345
Mailing Address - Street 1:5729 NW 151ST ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2481
Mailing Address - Country:US
Mailing Address - Phone:305-456-0345
Mailing Address - Fax:305-604-1515
Practice Address - Street 1:5729 NW 151ST ST
Practice Address - Street 2:SUITE #102
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2481
Practice Address - Country:US
Practice Address - Phone:305-456-0345
Practice Address - Fax:305-604-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20304261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy