Provider Demographics
NPI:1093875312
Name:PHYSICAL REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:PHYSICAL REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:786-277-5959
Mailing Address - Street 1:17670 NW 78TH AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3664
Mailing Address - Country:US
Mailing Address - Phone:305-362-7468
Mailing Address - Fax:305-362-7469
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-362-7468
Practice Address - Fax:305-362-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6689Medicare ID - Type UnspecifiedFLORIDA MEDICARE