Provider Demographics
NPI:1164086815
Name:PROHEALTH MEDICAL REHABILITATION INC.
Entity Type:Organization
Organization Name:PROHEALTH MEDICAL REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-815-3547
Mailing Address - Street 1:5190 NW 167TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6338
Mailing Address - Country:US
Mailing Address - Phone:786-440-5385
Mailing Address - Fax:786-520-3941
Practice Address - Street 1:5190 NW 167TH ST STE 304
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6338
Practice Address - Country:US
Practice Address - Phone:786-440-5385
Practice Address - Fax:786-520-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service