Healthcare Provider Details

I. General information

NPI: 1639505910
Provider Name (Legal Business Name): ALTERNATIVE REHAB & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 S MILITARY TRL SUITE 750
DELRAY BEACH FL
33484-6534
US

IV. Provider business mailing address

16244 S MILITARY TRL SUITE 750
DELRAY BEACH FL
33484-6534
US

V. Phone/Fax

Practice location:
  • Phone: 561-265-5251
  • Fax: 561-450-6716
Mailing address:
  • Phone: 561-265-5251
  • Fax: 561-450-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28186
License Number StateFL

VIII. Authorized Official

Name: MR. RONNIE BARGAYO
Title or Position: DIRECTOR OF SERIVCES
Credential: PHYSICAL THERAPIST
Phone: 561-265-5251