Provider Demographics
NPI:1073806121
Name:MG THERAPEUTIC REHABILITATION CORP
Entity Type:Organization
Organization Name:MG THERAPEUTIC REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILEIDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:786-991-4400
Mailing Address - Street 1:8567 CORAL WAY # 188
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2335
Mailing Address - Country:US
Mailing Address - Phone:786-991-4400
Mailing Address - Fax:
Practice Address - Street 1:901 SW 137TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3026
Practice Address - Country:US
Practice Address - Phone:786-991-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62651261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation