Provider Demographics
NPI:1174842801
Name:KREATIVE THERAPY & REHAB CENTER, INC
Entity Type:Organization
Organization Name:KREATIVE THERAPY & REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-319-0848
Mailing Address - Street 1:17300 NW 68TH AVE
Mailing Address - Street 2:117
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4014
Mailing Address - Country:US
Mailing Address - Phone:786-319-0848
Mailing Address - Fax:
Practice Address - Street 1:17300 NW 68TH AVE
Practice Address - Street 2:117
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4014
Practice Address - Country:US
Practice Address - Phone:786-319-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty