Provider Demographics
NPI:1497074751
Name:PROFESSIONAL THERAPY CENTER, INC
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-871-6722
Mailing Address - Street 1:6555 NW 36TH ST
Mailing Address - Street 2:SUITE 201-F
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6978
Mailing Address - Country:US
Mailing Address - Phone:305-871-6722
Mailing Address - Fax:305-871-6723
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:SUITE 201-F
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:305-871-6722
Practice Address - Fax:305-871-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy