Provider Demographics
NPI:1265470330
Name:PROREHAB CORP
Entity Type:Organization
Organization Name:PROREHAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALPARTIDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:305-461-3111
Mailing Address - Street 1:2828 CORAL WAY
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3214
Mailing Address - Country:US
Mailing Address - Phone:305-461-3111
Mailing Address - Fax:305-461-3339
Practice Address - Street 1:2828 SW 22ND ST
Practice Address - Street 2:SUITE # 307
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3214
Practice Address - Country:US
Practice Address - Phone:305-461-3111
Practice Address - Fax:305-461-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM15496261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7993Medicare ID - Type Unspecified