Provider Demographics
NPI:1003058306
Name:FLORIDA REHABILITATION CENTER,INC
Entity Type:Organization
Organization Name:FLORIDA REHABILITATION CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENITO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPY
Authorized Official - Phone:786-362-5083
Mailing Address - Street 1:913 SW 87TH AVE
Mailing Address - Street 2:SUITE 913
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3206
Mailing Address - Country:US
Mailing Address - Phone:786-362-5083
Mailing Address - Fax:786-362-5110
Practice Address - Street 1:913 SW 87TH AVE
Practice Address - Street 2:SUITE 913
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3206
Practice Address - Country:US
Practice Address - Phone:786-362-5083
Practice Address - Fax:786-362-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 46836247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty