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General NPI Number Information
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NPI Number | 1982979761
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Entity Type | Organization
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Legal Business Name | PROCARE REHAB AND WELLNESS INC.
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 2151 E COMMERCIAL BLVD STE 305
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3807
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Country | US
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Telephone | 954-446-9178
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Fax | 954-707-6302
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Provider Business Mailing Address
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Address Line | 2680 NE 20TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3023
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Country | US
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Telephone | 954-899-1144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL TRATHEN
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Credential | P.T.
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Telephone | 954-899-1144
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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 | PT 18120
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License Number State | FL
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