Provider Demographics
NPI:1689673444
Name:NEW AGE REHAB INC
Entity Type:Organization
Organization Name:NEW AGE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:AMPARO
Authorized Official - Last Name:BELTRAN-DULCEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:786-343-5557
Mailing Address - Street 1:2248 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5710
Mailing Address - Country:US
Mailing Address - Phone:786-343-5557
Mailing Address - Fax:305-229-7261
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:SUITE 100F
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:786-343-5557
Practice Address - Fax:305-229-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885842000Medicaid
FL6826776 96OtherHOME & COMM BASED SVCS
FL885842000Medicaid