Provider Demographics
NPI:1689860280
Name:MIAMI NEUROLOGY & REHABILITATION SPECIALISTS INC
Entity Type:Organization
Organization Name:MIAMI NEUROLOGY & REHABILITATION SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT19325
Authorized Official - Phone:305-661-8040
Mailing Address - Street 1:9335 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2324
Mailing Address - Country:US
Mailing Address - Phone:305-275-6346
Mailing Address - Fax:305-275-6347
Practice Address - Street 1:5975 SUNSET DR STE 405
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5198
Practice Address - Country:US
Practice Address - Phone:305-661-8040
Practice Address - Fax:305-661-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7698606OtherAETNA
FL607277300Medicaid
FL7698606OtherAETNA