Provider Demographics
NPI:1790713345
Name:IMPERIAL THERAPY CENTER, INC
Entity Type:Organization
Organization Name:IMPERIAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:305-722-0787
Mailing Address - Street 1:2721 SW 137TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6355
Mailing Address - Country:US
Mailing Address - Phone:305-722-0787
Mailing Address - Fax:786-237-0403
Practice Address - Street 1:2721 SW 137TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6355
Practice Address - Country:US
Practice Address - Phone:305-722-0787
Practice Address - Fax:786-237-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686831Medicare Oscar/Certification