MEDICARE: LA FORTALEZA PHYSICAL THERAPY 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

Other Identifiers

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

General Provider Information

NPI Number	:	1760134126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA FORTALEZA PHYSICAL THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	133 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2717
Country	:	US
Telephone Number	:	215-455-5370
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 1ST ST S STE 103-104
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3255
Country	:	US
Telephone Number	:	863-875-8355
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LUIS HINCAPIE
Credential	:
Telephone Number	:	215-455-5370

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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