Provider Demographics
NPI:1649449810
Name:ABC THERAPY CENTER CORP
Entity type:Organization
Organization Name:ABC THERAPY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PDT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-0508
Mailing Address - Street 1:330 SW 27TH AVE
Mailing Address - Street 2:STE 505
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2961
Mailing Address - Country:US
Mailing Address - Phone:305-649-0508
Mailing Address - Fax:305-649-0594
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:STE 505
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2961
Practice Address - Country:US
Practice Address - Phone:305-649-0508
Practice Address - Fax:305-649-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7122208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty