Organization
CHARLOTTE WORKERS COMP INJURY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH L AMARAL (OWNER)
(941) 575-8228
Entity
Organization
Contact information
Practice address
324 CROSS ST, PUNTA GORDA, FL 33950-4802
(941) 575-8228
(941) 575-9743
Mailing address
PO BOX 495665, PORT CHARLOTTE, FL 33949-5665
(941) 575-8228
(941) 575-9743
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MM8388
FL
225700000X
Massage Therapist
MM8900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157112XX
PREFERRED CARE
FL
01
—
2049755
AETNA
FL
01
—
Y916A
BCBS
FL
Enumeration date
09/16/2005
Last updated
04/26/2012
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