Provider Demographics
NPI:1225334956
Name:OPTIMUM REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:OPTIMUM REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LA COTERA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:786-417-1303
Mailing Address - Street 1:12039 SW 132ND CT
Mailing Address - Street 2:5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4783
Mailing Address - Country:US
Mailing Address - Phone:786-417-1303
Mailing Address - Fax:305-232-9693
Practice Address - Street 1:12039 SW 132ND CT
Practice Address - Street 2:5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4783
Practice Address - Country:US
Practice Address - Phone:786-417-1303
Practice Address - Fax:305-232-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12171261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation