Provider Demographics
NPI:1538151758
Name:ARCHIES REHAB CENTER INC
Entity type:Organization
Organization Name:ARCHIES REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDET
Authorized Official - Prefix:
Authorized Official - First Name:ARQUIMEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:321-506-4830
Mailing Address - Street 1:200 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3519
Mailing Address - Country:US
Mailing Address - Phone:321-506-4830
Mailing Address - Fax:321-220-0566
Practice Address - Street 1:200 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3519
Practice Address - Country:US
Practice Address - Phone:321-506-4830
Practice Address - Fax:321-220-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4517Medicare ID - Type UnspecifiedPROVIDER ID