Provider Demographics
NPI:1780131193
Name:VITALCARE PHYSICAL THERAPY AND REHABILITATION INC
Entity type:Organization
Organization Name:VITALCARE PHYSICAL THERAPY AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEARY DEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-501-1191
Mailing Address - Street 1:679 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3680
Mailing Address - Country:US
Mailing Address - Phone:305-606-2997
Mailing Address - Fax:
Practice Address - Street 1:679 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3680
Practice Address - Country:US
Practice Address - Phone:305-606-2997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty