Provider Demographics
NPI:1033317318
Name:REHAB INDEPENDENCE
Entity Type:Organization
Organization Name:REHAB INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHAUNTE
Authorized Official - Middle Name:TRENISE
Authorized Official - Last Name:WEECH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:786-277-2570
Mailing Address - Street 1:20255 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2518
Mailing Address - Country:US
Mailing Address - Phone:305-651-1757
Mailing Address - Fax:
Practice Address - Street 1:20255 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2518
Practice Address - Country:US
Practice Address - Phone:305-651-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11897251E00000X, 302F00000X, 302R00000X, 305R00000X, 305S00000X
FLPTA 18652251E00000X, 302R00000X
FLPTA18652305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered302F00000XManaged Care OrganizationsExclusive Provider Organization
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization
Not Answered305R00000XManaged Care OrganizationsPreferred Provider Organization
Not Answered305S00000XManaged Care OrganizationsPoint of Service