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Organization
TANA RECOVERY PLACE LLC
Active
Organization
TANA RECOVERY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS MIGUEL OCQUE (MEMBER)
(954) 330-8077
Entity
Organization
Contact information
Practice address
13297 NW 18TH ST, PEMBROKE PINES, FL 33028-2502
(954) 330-8077
Mailing address
13297 NW 18TH ST, PEMBROKE PINES, FL 33028-2502
(954) 330-8077
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251N0400X
Neurology Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/03/2022
Last updated
11/03/2022
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