=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902009525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION ALTERNATIVE THERAPY & SPA CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2007
-----------------------------------------------------
Last Update Date | 11/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2665 CLEVELAND AVE STE 205
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-362-3314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2665 CLEVELAND AVE STE 205
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-362-3314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LUIS A ALVAREZ
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 239-362-3314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | HCC12832
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------