Provider Demographics
NPI:1972521938
Name:PROFESSIONAL TECHNICIAN REHABILITATION CORP
Entity Type:Organization
Organization Name:PROFESSIONAL TECHNICIAN REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-0708
Mailing Address - Street 1:42 NW 27TH AVE
Mailing Address - Street 2:SUITE 323
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5127
Mailing Address - Country:US
Mailing Address - Phone:305-642-0708
Mailing Address - Fax:305-642-6989
Practice Address - Street 1:42 NW 27TH AVE
Practice Address - Street 2:SUITE 323
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5127
Practice Address - Country:US
Practice Address - Phone:305-642-0708
Practice Address - Fax:305-642-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684807Medicare ID - Type UnspecifiedCORF