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General NPI Number Information
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NPI Number | 1760134126
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Entity Type | Organization
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Legal Business Name | LA FORTALEZA PHYSICAL THERAPY CENTER INC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 205 1ST ST S STE 103-104
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3255
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Country | US
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Telephone | 863-875-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 133 W HUNTING PARK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2717
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Country | US
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Telephone | 215-455-5370
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LUIS HINCAPIE
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Credential |
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Telephone | 215-455-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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