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General NPI Number Information
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NPI Number | 1497462972
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Entity Type | Organization
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Legal Business Name | TANA RECOVERY PLACE LLC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 13297 NW 18TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2502
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Country | US
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Telephone | 954-330-8077
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Fax |
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Provider Business Mailing Address
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Address Line | 13297 NW 18TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2502
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Country | US
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Telephone | 954-330-8077
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CARLOS MIGUEL OCQUE
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Credential |
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Telephone | 954-330-8077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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