MEDICARE: ARCHIES 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	3426	FL

General Provider Information

NPI Number	:	1538151758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHIES REHAB CENTER INC

Provider Business Mailing Address
First Line	:	200 MIAMI AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3519
Country	:	US
Telephone Number	:	321-506-4830
Fax Number	:	321-220-0566

Provider Business Practice Location Address
First Line	:	200 MIAMI AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3519
Country	:	US
Telephone Number	:	321-506-4830
Fax Number	:	321-220-0566

Authorized Official
Title or Position	:	PRESIDET
Name	:	ARQUIMEDES LOPES
Credential	:	RPT
Telephone Number	:	321-506-4830

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/02/2011

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