MEDICARE: PROFESSIONAL THERAPEUTIC HEALTH CARE 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1285772624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL THERAPEUTIC HEALTH CARE INC

Provider Business Mailing Address
First Line	:	3618 LANTANA RD STE 202
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:	561-964-2526
Fax Number	:	561-964-7885

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD STE 202
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2247
Country	:	US
Telephone Number	:	561-964-2526
Fax Number	:	561-964-7885

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ALEIDA V DOMINGUEZ
Credential	:
Telephone Number	:	561-964-2526

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	10/12/2020

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