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General NPI Number Information
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NPI Number | 1528386422
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Entity Type | Organization
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Legal Business Name | FDC UNIVERSAL THERAPY CENTER INC
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 85 GRAND CANAL DR SUITE 300
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City | MIAMI
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State | FL
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Zip | 33144-2561
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Country | US
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Telephone | 305-262-5123
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Fax | 305-262-5131
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Provider Business Mailing Address
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Address Line | 85 GRAND CANAL DR
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City | MIAMI
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State | FL
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Zip | 33144-2561
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Country | US
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Telephone | 305-262-5123
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Fax | 305-262-5131
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FRANCISCO DE LA CRUZ
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Credential | P
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Telephone | 305-262-5123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | MA 31311
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License Number State | FL
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