Provider Demographics
NPI:1376640961
Name:ALLY PHYSICAL THERAPY CENTERI INC.
Entity type:Organization
Organization Name:ALLY PHYSICAL THERAPY CENTERI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:RIVERA-MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:407-970-0907
Mailing Address - Street 1:10622 STRADFORD ROW
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2041
Mailing Address - Country:US
Mailing Address - Phone:407-970-0907
Mailing Address - Fax:407-260-5411
Practice Address - Street 1:10622 STRADFORD ROW
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2041
Practice Address - Country:US
Practice Address - Phone:407-970-0907
Practice Address - Fax:407-260-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 37462251N0400X
FLPT37462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000030871OtherCMS KIDS
FL882116000Medicaid
FL882116096OtherMED WAIVER
FL000000030871OtherCMS KIDS