Provider Demographics
NPI:1225338817
Name:PRACTICE REHABILITATION CENTER
Entity Type:Organization
Organization Name:PRACTICE REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:PILETA
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:305-825-8818
Mailing Address - Street 1:13903 NW 67TH AVE
Mailing Address - Street 2:330
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2900
Mailing Address - Country:US
Mailing Address - Phone:305-825-8819
Mailing Address - Fax:
Practice Address - Street 1:13903 NW 67TH AVE
Practice Address - Street 2:330
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-2900
Practice Address - Country:US
Practice Address - Phone:305-825-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25692261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center