MEDICARE: ULTRA MEDICAL AND REHAB CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT19318	FL

General Provider Information

NPI Number	:	1255399150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA MEDICAL AND REHAB CENTER INC

Provider Business Mailing Address
First Line	:	6363 TAFT STREET SUITE 311
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-0000
Country	:	US
Telephone Number	:	954-987-1975
Fax Number	:	954-987-1355

Provider Business Practice Location Address
First Line	:	6363 TAFT ST
Second Line	:	SUITE 311
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5962
Country	:	US
Telephone Number	:	954-987-1975
Fax Number	:	954-987-1355

Authorized Official
Title or Position	:	P
Name	:	GILBERT SANABRIA JR.
Credential	:
Telephone Number	:	954-987-1975

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/22/2020

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