MEDICARE: ADVANCE THERAPY & REHAB CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	21975 HCC939	FL

General Provider Information

NPI Number	:	1992136857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE THERAPY & REHAB CENTER INC

Provider Business Mailing Address
First Line	:	221 MAJORCA AVE APT 4
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4434
Country	:	US
Telephone Number	:	305-582-1593
Fax Number	:	786-228-4941

Provider Business Practice Location Address
First Line	:	221 MAJORCA AVE APT 4
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4434
Country	:	US
Telephone Number	:	305-582-1593
Fax Number	:	786-228-4941

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICARDO ORTEGA
Credential	:
Telephone Number	:	305-582-1593

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	12/04/2013

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