Provider Demographics
NPI:1558633065
Name:SUPERIOR REHAB & THERAPY CENTER CORP.
Entity Type:Organization
Organization Name:SUPERIOR REHAB & THERAPY CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MENENDEZ OVEIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:305-264-9100
Mailing Address - Street 1:7483 SW 24TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1454
Mailing Address - Country:US
Mailing Address - Phone:305-264-9100
Mailing Address - Fax:305-264-9101
Practice Address - Street 1:7483 SW 24TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1454
Practice Address - Country:US
Practice Address - Phone:305-264-9100
Practice Address - Fax:305-264-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty