Provider Demographics
NPI:1790065662
Name:FIRST PHYSICAL AND REHABILITATION, CORP
Entity Type:Organization
Organization Name:FIRST PHYSICAL AND REHABILITATION, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARRALERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-8999
Mailing Address - Street 1:701 NW 57TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3275
Mailing Address - Country:US
Mailing Address - Phone:305-261-8999
Mailing Address - Fax:305-269-7003
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3275
Practice Address - Country:US
Practice Address - Phone:305-261-8999
Practice Address - Fax:305-269-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center