Provider Demographics
NPI:1679788665
Name:CKC RREHABILITATION CORP
Entity Type:Organization
Organization Name:CKC RREHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPITIA-MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, GCS
Authorized Official - Phone:305-793-2069
Mailing Address - Street 1:92 NE 139TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2756
Mailing Address - Country:US
Mailing Address - Phone:305-793-2069
Mailing Address - Fax:305-685-5911
Practice Address - Street 1:92 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2756
Practice Address - Country:US
Practice Address - Phone:305-793-2069
Practice Address - Fax:305-685-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT12700OtherPHYSICAL THERAPY LICENSE
FL1457443541Medicaid
1457443541OtherINDIVIDUAL NPI