Provider Demographics
NPI:1669627709
Name:ORTHOPEDIC REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MAZZOTLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-445-5056
Mailing Address - Street 1:2601 SW 37TH AV #607
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-445-5056
Mailing Address - Fax:305-445-2023
Practice Address - Street 1:2601 SW 37TH AV #607
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-445-5056
Practice Address - Fax:305-445-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8707111N00000X
FLME98523207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty