Provider Demographics
NPI:1558686139
Name:INJURY TREATMENT CENTER OF MIAMI
Entity Type:Organization
Organization Name:INJURY TREATMENT CENTER OF MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ-NOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-640-8280
Mailing Address - Street 1:3485 W FLAGLER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1042
Mailing Address - Country:US
Mailing Address - Phone:305-640-8280
Mailing Address - Fax:305-640-8331
Practice Address - Street 1:3485 W FLAGLER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1042
Practice Address - Country:US
Practice Address - Phone:305-640-8280
Practice Address - Fax:305-640-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53247172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty