MEDICARE: LIFE QUALITY REHABILITATIVE SERVICES 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1285794313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE QUALITY REHABILITATIVE SERVICES INC.

Provider Business Mailing Address
First Line	:	7025 BERACASA WAY
Second Line	:	SUITE #101
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3443
Country	:	US
Telephone Number	:	561-869-0867
Fax Number	:	561-869-0868

Provider Business Practice Location Address
First Line	:	7025 BERACASA WAY
Second Line	:	SUITE #101
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3443
Country	:	US
Telephone Number	:	561-869-0867
Fax Number	:	561-869-0868

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	DIANE SIWEK
Credential	:	PT
Telephone Number	:	561-869-0867

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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