Provider Demographics
NPI:1316573462
Name:WEST THERAPY CENTER LLC
Entity Type:Organization
Organization Name:WEST THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHORIZED OFFICIAL
Authorized Official - Phone:305-972-3408
Mailing Address - Street 1:175 FOUNTAINBLEAU BLVD STE 2G11
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7012
Mailing Address - Country:US
Mailing Address - Phone:786-870-5931
Mailing Address - Fax:
Practice Address - Street 1:175 FOUNTAINBLEAU BLVD STE 2G-11
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7012
Practice Address - Country:US
Practice Address - Phone:786-870-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA40609OtherMA