Provider Demographics
NPI:1326072208
Name:T&R REHAB AND DIAGNOSTIC CENTER, INC
Entity Type:Organization
Organization Name:T&R REHAB AND DIAGNOSTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:DEL CARMEN
Authorized Official - Last Name:REVERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-821-8889
Mailing Address - Street 1:3412 W 84TH STREET
Mailing Address - Street 2:UNIT #110
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-821-8889
Mailing Address - Fax:305-824-1511
Practice Address - Street 1:3412 W 84TH STREET
Practice Address - Street 2:UNIT #110
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-821-8889
Practice Address - Fax:305-824-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890184800Medicaid