Provider Demographics
NPI:1760590996
Name:SOUTH MIAMI SPORTMEDICINE & HAND THERAPY CENTER INC
Entity Type:Organization
Organization Name:SOUTH MIAMI SPORTMEDICINE & HAND THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MILLARES
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL CHT
Authorized Official - Phone:305-666-7116
Mailing Address - Street 1:7000 SW 62 AVE
Mailing Address - Street 2:#120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-666-7116
Mailing Address - Fax:305-666-7168
Practice Address - Street 1:7000 SW 62 AVE
Practice Address - Street 2:#120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-666-7116
Practice Address - Fax:305-666-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902EOtherBCBS
FLK2815Medicare ID - Type Unspecified