Healthcare Provider Details

I. General information

NPI: 1295592228
Provider Name (Legal Business Name): ALLIANCE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 WHISPERING TRAILS AVE
WINTER HAVEN FL
33884-1826
US

IV. Provider business mailing address

3210 WHISPERING TRAILS AVE
WINTER HAVEN FL
33884-1826
US

V. Phone/Fax

Practice location:
  • Phone: 863-651-3040
  • Fax:
Mailing address:
  • Phone: 863-651-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: IVAN LOPEZLLAVORE
Title or Position: MANAGER
Credential: PTA
Phone: 863-651-3040