MEDICARE: VITALCARE PHYSICAL THERAPY AND REHABILITATION 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	PT26290	FL

General Provider Information

NPI Number	:	1780131193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALCARE PHYSICAL THERAPY AND REHABILITATION INC

Provider Business Mailing Address
First Line	:	679 WISTERIA WAY
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-3680
Country	:	US
Telephone Number	:	305-606-2997
Fax Number	:

Provider Business Practice Location Address
First Line	:	679 WISTERIA WAY
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-3680
Country	:	US
Telephone Number	:	305-606-2997
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEARY DEAN D MCINTOSH
Credential	:
Telephone Number	:	954-501-1191

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	03/30/2018

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