Provider Demographics
NPI:1629372438
Name:WEST KENDALL REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:WEST KENDALL REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-401-6775
Mailing Address - Street 1:8785 SW 165TH AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5826
Mailing Address - Country:US
Mailing Address - Phone:786-401-6775
Mailing Address - Fax:786-401-6779
Practice Address - Street 1:8785 SW 165TH AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5826
Practice Address - Country:US
Practice Address - Phone:786-401-6775
Practice Address - Fax:786-401-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation