Provider Demographics
NPI:1518666494
Name:VA PHYSICAL REHABILITATION CORP
Entity Type:Organization
Organization Name:VA PHYSICAL REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-778-6071
Mailing Address - Street 1:974 OLD DIXIE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4933
Mailing Address - Country:US
Mailing Address - Phone:305-778-6071
Mailing Address - Fax:786-292-2842
Practice Address - Street 1:974 OLD DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4933
Practice Address - Country:US
Practice Address - Phone:305-778-6071
Practice Address - Fax:786-292-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty