=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255606950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VLO THERAPY REHABILITATION CENTER. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 03/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1870 FOREST HILL BLVD STE 101
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-6057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-434-0005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1870 FOREST HILL BLVD SUITE 101
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/THERAPIST
-----------------------------------------------------
Name | FIDEL MACHIN III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-434-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | MM28649
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------