Provider Demographics
NPI:1679796577
Name:MEGA THERAPY CENTER, INC,
Entity type:Organization
Organization Name:MEGA THERAPY CENTER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-326-7777
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE 204-205
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:305-326-7777
Mailing Address - Fax:305-326-7797
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 204-205
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:305-326-7777
Practice Address - Fax:305-326-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL684872261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684872Medicare Oscar/Certification