Provider Demographics
NPI:1518939412
Name:ANC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ANC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-591-3284
Mailing Address - Street 1:4615 NW 72ND AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5689
Mailing Address - Country:US
Mailing Address - Phone:305-591-3284
Mailing Address - Fax:305-594-3093
Practice Address - Street 1:4615 NW 72ND AVE
Practice Address - Street 2:STE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5689
Practice Address - Country:US
Practice Address - Phone:305-591-3284
Practice Address - Fax:305-594-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686799Medicare Oscar/Certification