Provider Demographics
NPI:1417007048
Name:CHARRIS REHAB, INC
Entity Type:Organization
Organization Name:CHARRIS REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:786-621-7860
Mailing Address - Street 1:4005 NW 114TH AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4374
Mailing Address - Country:US
Mailing Address - Phone:305-824-1818
Mailing Address - Fax:786-621-7861
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-824-1818
Practice Address - Fax:786-621-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2734Medicare ID - Type Unspecified