Provider Demographics
NPI:1467517714
Name:THE DIVINE CHILD REHAB INC
Entity Type:Organization
Organization Name:THE DIVINE CHILD REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEY
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:561-856-2809
Mailing Address - Street 1:6365 SQUIREWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-641-6740
Mailing Address - Fax:561-641-6739
Practice Address - Street 1:3900 WOODLAKE BLVD
Practice Address - Street 2:SUITE 301 A
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3044
Practice Address - Country:US
Practice Address - Phone:561-641-6740
Practice Address - Fax:561-641-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT21900OtherPHYSICAL THERAPIST FL LIC
FLK9403Medicare PIN
FLPT21900OtherPHYSICAL THERAPIST FL LIC