Provider Demographics
NPI:1609855527
Name:DE LEON REHAB
Entity Type:Organization
Organization Name:DE LEON REHAB
Other - Org Name:DE LEON REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CLEMENCIA
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:R,PT
Authorized Official - Phone:305-698-2273
Mailing Address - Street 1:5803 NW 151ST ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2478
Mailing Address - Country:US
Mailing Address - Phone:954-540-8907
Mailing Address - Fax:305-698-8930
Practice Address - Street 1:5803 NW 151ST ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2478
Practice Address - Country:US
Practice Address - Phone:954-540-8907
Practice Address - Fax:305-698-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
E6986Medicare ID - Type Unspecified