Provider Demographics
NPI:1407905904
Name:ULTIMATE REHAB INC
Entity Type:Organization
Organization Name:ULTIMATE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILAGRO
Authorized Official - Middle Name:MARISELA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-944-8290
Mailing Address - Street 1:1770 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5301
Mailing Address - Country:US
Mailing Address - Phone:305-944-8290
Mailing Address - Fax:305-944-8061
Practice Address - Street 1:1770 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33179-5301
Practice Address - Country:US
Practice Address - Phone:305-944-8290
Practice Address - Fax:305-944-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4518Medicare PIN