Provider Demographics
NPI:1982699807
Name:CHARLOTTE WORKERS COMP INJURY CENTER INC
Entity Type:Organization
Organization Name:CHARLOTTE WORKERS COMP INJURY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMARAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-575-8228
Mailing Address - Street 1:PO BOX 495665
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5665
Mailing Address - Country:US
Mailing Address - Phone:941-575-8228
Mailing Address - Fax:941-575-9743
Practice Address - Street 1:324 CROSS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4802
Practice Address - Country:US
Practice Address - Phone:941-575-8228
Practice Address - Fax:941-575-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM8388225700000X
FLMM8900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL157112XXOtherPREFERRED CARE
FLY916AOtherBCBS
FL2049755OtherAETNA
FL157112XXOtherPREFERRED CARE
FL2049755OtherAETNA
FLCJ6196Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER