Provider Demographics
NPI:1043539455
Name:EXCEPTIONAL KIDZ REHAB ACADEMY INC.
Entity Type:Organization
Organization Name:EXCEPTIONAL KIDZ REHAB ACADEMY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-310-3267
Mailing Address - Street 1:1414 NW 107TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:305-310-3267
Mailing Address - Fax:305-594-9282
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:305-310-3267
Practice Address - Fax:305-594-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization