Healthcare Provider Details

I. General information

NPI: 1982979761
Provider Name (Legal Business Name): PROCARE REHAB AND WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 E COMMERCIAL BLVD STE 305
FORT LAUDERDALE FL
33308-3807
US

IV. Provider business mailing address

2680 NE 20TH ST
POMPANO BEACH FL
33062-3023
US

V. Phone/Fax

Practice location:
  • Phone: 954-446-9178
  • Fax: 954-707-6302
Mailing address:
  • Phone: 954-899-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 18120
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL TRATHEN
Title or Position: OWNER
Credential: P.T.
Phone: 954-899-1144