Provider Demographics
NPI:1578784922
Name:QUALITY CARE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:QUALITY CARE PHYSICAL THERAPY, INC.
Other - Org Name:QUALITY CARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AVITO
Authorized Official - Middle Name:VELOSO
Authorized Official - Last Name:VANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-810-0173
Mailing Address - Street 1:9460 REDHAWK BEND LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2126
Mailing Address - Country:US
Mailing Address - Phone:727-810-0173
Mailing Address - Fax:863-858-9406
Practice Address - Street 1:9460 REDHAWK BEND LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2126
Practice Address - Country:US
Practice Address - Phone:727-810-0173
Practice Address - Fax:863-815-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty