Provider Demographics
NPI:1114205689
Name:BELLISIMA REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:BELLISIMA REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-0357
Mailing Address - Street 1:7171 SW 24TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1691
Mailing Address - Country:US
Mailing Address - Phone:305-267-2400
Mailing Address - Fax:305-267-4470
Practice Address - Street 1:7171 SW 24TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1691
Practice Address - Country:US
Practice Address - Phone:305-267-2400
Practice Address - Fax:305-267-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy