Provider Demographics
NPI:1497828933
Name:MIAMI BACK INSTITUTE
Entity Type:Organization
Organization Name:MIAMI BACK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-461-4848
Mailing Address - Street 1:1825 PONCE DE LEON BLVD # 387
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4418
Mailing Address - Country:US
Mailing Address - Phone:305-461-4848
Mailing Address - Fax:305-461-4899
Practice Address - Street 1:315 PALERMO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6607
Practice Address - Country:US
Practice Address - Phone:305-461-4848
Practice Address - Fax:305-461-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty