Provider Demographics
NPI:1255318333
Name:SOUTH MIAMI REHABILITATION, INC.
Entity Type:Organization
Organization Name:SOUTH MIAMI REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-237-9720
Mailing Address - Street 1:8390 W FLAGLER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2039
Mailing Address - Country:US
Mailing Address - Phone:305-480-5688
Mailing Address - Fax:305-480-5680
Practice Address - Street 1:8390 W FLAGLER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2039
Practice Address - Country:US
Practice Address - Phone:305-480-5688
Practice Address - Fax:305-480-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL683224261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683224Medicare Oscar/Certification