=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366077547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESURGENCE CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2020
-----------------------------------------------------
Last Update Date | 03/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 537 E CENTRAL AVE STE A
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33880-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-307-3005
-----------------------------------------------------
Fax | 863-307-3005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1696
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33882-1696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-307-3005
-----------------------------------------------------
Fax | 863-307-3005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBR
-----------------------------------------------------
Name | MR. EDWIN MUNOZ SORIANO
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 863-412-5479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------