Provider Demographics
NPI:1891072096
Name:PRESTIGE MASSAGE & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:PRESTIGE MASSAGE & REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:SERAFIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:407-579-1045
Mailing Address - Street 1:2614 E COLONIAL DR
Mailing Address - Street 2:SUITE 400-5
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5028
Mailing Address - Country:US
Mailing Address - Phone:407-579-1045
Mailing Address - Fax:
Practice Address - Street 1:2614 E COLONIAL DR
Practice Address - Street 2:SUITE 400-5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5028
Practice Address - Country:US
Practice Address - Phone:407-579-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47012261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy