Provider Demographics
NPI:1720363724
Name:J.M. REHABILITATION CENTER CORP
Entity Type:Organization
Organization Name:J.M. REHABILITATION CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATARREDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-9908
Mailing Address - Street 1:10300 SW 72ND ST STE 157
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3038
Mailing Address - Country:US
Mailing Address - Phone:305-603-9908
Mailing Address - Fax:305-603-9910
Practice Address - Street 1:10300 SW 72ND ST STE 157
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3038
Practice Address - Country:US
Practice Address - Phone:305-603-9908
Practice Address - Fax:305-603-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM26738261QP1100X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric