Provider Demographics
NPI:1386030328
Name:PHYSICAL THERAPY AT DORAL ,LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AT DORAL ,LLC
Other - Org Name:INTEGRA REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALESSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-537-7227
Mailing Address - Street 1:8725 NW 18TH TER STE 211
Mailing Address - Street 2:14253 SW 21 TERRACE
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8725 NW 18 TERRACE SUITE 211
Practice Address - Street 2:INTEGRA REHABILITATION
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172
Practice Address - Country:US
Practice Address - Phone:305-537-7227
Practice Address - Fax:305-537-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT847261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083889059OtherMEDICARE ACHA