Basic Information
| Provider Information | |||||||||
| NPI: | 1982979761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROCARE REHAB AND WELLNESS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 NE 20TH ST | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330623023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548991144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2151 E COMMERCIAL BLVD STE 305 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333083807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544469178 | ||||||||
| FaxNumber: | 9547076302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2012 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | TRATHEN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9548991144 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT 18120 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.