Provider Demographics
NPI:1265485981
Name:SOUTH BROWARD REHABILITATON
Entity Type:Organization
Organization Name:SOUTH BROWARD REHABILITATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-0096
Mailing Address - Street 1:1570 W 38TH PL
Mailing Address - Street 2:STE 3 & 4
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7012
Mailing Address - Country:US
Mailing Address - Phone:305-698-0096
Mailing Address - Fax:305-698-0098
Practice Address - Street 1:1570 W 38TH PL
Practice Address - Street 2:STE 3 & 4
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7012
Practice Address - Country:US
Practice Address - Phone:305-698-0096
Practice Address - Fax:305-698-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL541102-0225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9036Medicare ID - Type Unspecified