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General NPI Number Information
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NPI Number | 1891072096
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Entity Type | Organization
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Legal Business Name | PRESTIGE MASSAGE & REHAB CENTER, LLC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 2614 E COLONIAL DR SUITE 400-5
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City | ORLANDO
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State | FL
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Zip | 32803-5028
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Country | US
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Telephone | 407-579-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 E COLONIAL DR SUITE 400-5
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City | ORLANDO
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State | FL
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Zip | 32803-5028
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Country | US
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Telephone | 407-579-1045
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | SERAFIN M MENENCIA
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Credential | MT
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Telephone | 407-579-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA47012
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License Number State | FL
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