Healthcare Provider Details

I. General information

NPI: 1073988648
Provider Name (Legal Business Name): PRESERVA THERAPY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E STUART AVE
LAKE WALES FL
33853-4127
US

IV. Provider business mailing address

PO BOX 152
BABSON PARK FL
33827-0152
US

V. Phone/Fax

Practice location:
  • Phone: 863-314-8940
  • Fax: 863-385-0508
Mailing address:
  • Phone: 863-658-1797
  • Fax: 863-385-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT18312
License Number StateFL

VIII. Authorized Official

Name: MRS. MICHELLE RICE ALVAREZ
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 863-658-1797