Provider Demographics
NPI:1124011069
Name:THERA HEALTH REHAB CONSULTING MARKETING INC
Entity Type:Organization
Organization Name:THERA HEALTH REHAB CONSULTING MARKETING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUENGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-598-1099
Mailing Address - Street 1:10110 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2760
Mailing Address - Country:US
Mailing Address - Phone:305-598-1099
Mailing Address - Fax:305-598-6673
Practice Address - Street 1:10110 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2760
Practice Address - Country:US
Practice Address - Phone:305-598-1099
Practice Address - Fax:305-598-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRD8OtherBLUE CROSS BLUE SHIELD
686687Medicare Oscar/Certification