Healthcare Provider Details

I. General information

NPI: 1104810597
Provider Name (Legal Business Name): QUALITY CARE THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CANARY ISLAND DR
WESTON FL
33327-2353
US

IV. Provider business mailing address

1395 CANARY ISLAND DR
WESTON FL
33327-2353
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-8566
  • Fax: 954-239-7777
Mailing address:
  • Phone: 954-385-8566
  • Fax: 954-239-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE CAMACHO
Title or Position: MANAGER
Credential:
Phone: 954-385-8566