MEDICARE: VLO THERAPY REHABILITATION 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	261QR0400X	Rehabilitation Clinic/Center	MM28649	FL

General Provider Information

NPI Number	:	1255606950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VLO THERAPY REHABILITATION CENTER. INC

Provider Business Mailing Address
First Line	:	1870 FOREST HILL BLVD SUITE 101
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 FOREST HILL BLVD STE 101
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6057
Country	:	US
Telephone Number	:	561-434-0005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/THERAPIST
Name	:	FIDEL MACHIN III
Credential	:
Telephone Number	:	561-434-0005

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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