Healthcare Provider Details

I. General information

NPI: 1184498743
Provider Name (Legal Business Name): LIFE REHAB AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 S SEMORAN BLVD
ORLANDO FL
32807-1480
US

IV. Provider business mailing address

PO BOX 570038
ORLANDO FL
32857-0038
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-1112
  • Fax: 407-930-1114
Mailing address:
  • Phone: 407-930-1112
  • Fax: 407-930-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARCILIO ALVARADO
Title or Position: PRESIDENT
Credential:
Phone: 407-930-1112