Organization
ADVANCED REHAB CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EHAB BOULOS RPT (PRESIDENT)
(312) 383-0889
Entity
Organization
Contact information
Practice address
4401 S HOPKINS AVE, TITUSVILLE, FL 32780-6679
(321) 383-0889
(321) 383-0898
Mailing address
4401 S HOPKINS AVE, TITUSVILLE, FL 32780-6679
(321) 383-0889
(321) 383-0898
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT10247
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16170.1
HEALTH FIRST HEALTH PLAN
FL
01
—
23906
SOUTH CARE
FL
01
—
9407570
PRIVATE HEALTH CARE
FL
01
—
Y083U
BCBSF
FL
Enumeration date
08/21/2006
Last updated
04/20/2008
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