Healthcare Provider Details

I. General information

NPI: 1760134126
Provider Name (Legal Business Name): LA FORTALEZA PHYSICAL THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 1ST ST S STE 103-104
WINTER HAVEN FL
33880-3255
US

IV. Provider business mailing address

133 W HUNTING PARK AVE
PHILADELPHIA PA
19140-2717
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-8355
  • Fax:
Mailing address:
  • Phone: 215-455-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LUIS HINCAPIE
Title or Position: DIRECTOR
Credential:
Phone: 215-455-5370