Provider Demographics
NPI:1073991568
Name:MIAMI REHAB CENTER, INC
Entity Type:Organization
Organization Name:MIAMI REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-553-2002
Mailing Address - Street 1:11300 NW 87TH CT
Mailing Address - Street 2:SUITE # 157
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4586
Mailing Address - Country:US
Mailing Address - Phone:786-762-3915
Mailing Address - Fax:786-762-3916
Practice Address - Street 1:11300 NW 87TH CT
Practice Address - Street 2:SUITE # 157
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4586
Practice Address - Country:US
Practice Address - Phone:786-762-3915
Practice Address - Fax:786-762-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22682261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22682OtherPHYSICAL THERAPIST