Healthcare Provider Details

I. General information

NPI: 1255606950
Provider Name (Legal Business Name): VLO THERAPY REHABILITATION CENTER. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1870 FOREST HILL BLVD STE 101
WEST PALM BEACH FL
33406-6057
US

IV. Provider business mailing address

1870 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33406
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMM28649
License Number StateFL

VIII. Authorized Official

Name: FIDEL MACHIN III
Title or Position: PRESIDENT/THERAPIST
Credential:
Phone: 561-434-0005