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General NPI Number Information
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NPI Number | 1164937173
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Entity Type | Organization
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Legal Business Name | PELVICORE REHAB
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 7376 WEXFORD TER
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City | BOCA RATON
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State | FL
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Zip | 33433-4158
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Country | US
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Telephone | 201-704-4411
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Fax | 561-409-4972
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Provider Business Mailing Address
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Address Line | 7376 WEXFORD TER
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City | BOCA RATON
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State | FL
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Zip | 33433-4158
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Country | US
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Telephone | 201-704-4411
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Fax | 561-409-4972
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Authorized Official
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Title or Position | PT
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Name | SUSAN WINOGRAD
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Credential | PT
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Telephone | 561-295-1631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT28158
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License Number State | FL
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