Provider Demographics
NPI:1073832036
Name:ALFONSO REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:ALFONSO REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-200-5835
Mailing Address - Street 1:962 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4271
Mailing Address - Country:US
Mailing Address - Phone:305-200-5835
Mailing Address - Fax:305-392-0765
Practice Address - Street 1:962 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4271
Practice Address - Country:US
Practice Address - Phone:305-200-5835
Practice Address - Fax:305-392-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51067261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy