Provider Demographics
NPI:1184698185
Name:VICORY REHABILITATION, INC.
Entity type:Organization
Organization Name:VICORY REHABILITATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:VICORY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-814-0436
Mailing Address - Street 1:709 MUIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2688
Mailing Address - Country:US
Mailing Address - Phone:407-814-9806
Mailing Address - Fax:407-814-9806
Practice Address - Street 1:1509 W ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2640
Practice Address - Country:US
Practice Address - Phone:407-814-0436
Practice Address - Fax:407-814-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty