Provider Demographics
NPI:1922107820
Name:EMERALD HILLS REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:EMERALD HILLS REHABILITATION CENTER INC
Other - Org Name:THE SPORT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-989-5255
Mailing Address - Street 1:3850 SHERIDAN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-989-5255
Mailing Address - Fax:954-962-6445
Practice Address - Street 1:3850 SHERIDAN STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-989-5255
Practice Address - Fax:954-962-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2021225100000X
FLPT19559225100000X
FLPT22241225100000X
FLPT32161225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1131310OtherUNITED HEALTHCARE
FL228790OtherAVMED
FL372531000OtherUS DEPARTAMENT OF LABOR
FL2072908OtherAETNA HMO
FLK1489OtherMEDICARE PTAN
FL4565667OtherAETNA PPO
FLY914ROtherBLUE CROSS BLUE SHIELD