MEDICARE: ANN STORCK CENTER, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number State
1	225100000X	Physical Therapist	FL
2	2251P0200X	Pediatric Physical Therapist	FL
3	261QM1300X	Multi-Specialty Clinic/Center	FL
4	261QP2000X	Physical Therapy Clinic/Center	FL
5	261QR0400X	Rehabilitation Clinic/Center	FL
6	225X00000X	Occupational Therapist	FL
7	225XP0200X	Pediatric Occupational Therapist	FL
8	235Z00000X	Speech-Language Pathologist	FL
9	251C00000X	Developmentally Disabled Services Day Training Agency	FL
10	261QH0100X	Health Service Clinic/Center	FL
11	103K00000X	Behavior Analyst
12	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1730229212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN STORCK CENTER, INC.

Provider Business Mailing Address
First Line	:	1790 SW 43RD WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33317-5701
Country	:	US
Telephone Number	:	954-584-8000
Fax Number	:	954-321-8863

Provider Business Practice Location Address
First Line	:	1790 SW 43RD WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33317-5701
Country	:	US
Telephone Number	:	954-584-8000
Fax Number	:	954-321-8863

Authorized Official
Title or Position	:	DIRECTOR OF ACCOUNTING
Name	:	TONITA GREGORY
Credential	:
Telephone Number	:	954-584-8000

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/11/2021