Provider Demographics
NPI:1407897291
Name:X-TREME REHAB, INC.
Entity Type:Organization
Organization Name:X-TREME REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-271-6767
Mailing Address - Street 1:2423 SW 147TH AVE
Mailing Address - Street 2:137
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4082
Mailing Address - Country:US
Mailing Address - Phone:786-271-6767
Mailing Address - Fax:786-271-6767
Practice Address - Street 1:2423 SW 147TH AVE
Practice Address - Street 2:137
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4082
Practice Address - Country:US
Practice Address - Phone:786-271-6767
Practice Address - Fax:786-271-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19308225100000X
FLPT 18772225100000X
FLOT 2263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3971Medicare ID - Type UnspecifiedPROVIDER NUMBER