Provider Demographics
NPI:1790975126
Name:PLANT CITY REHAB AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:PLANT CITY REHAB AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VECINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-759-0106
Mailing Address - Street 1:1507 S ALEXANDER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-8413
Mailing Address - Country:US
Mailing Address - Phone:813-759-0106
Mailing Address - Fax:813-759-0161
Practice Address - Street 1:1507 S ALEXANDER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-8413
Practice Address - Country:US
Practice Address - Phone:813-759-0106
Practice Address - Fax:813-759-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12682208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty