Provider Demographics
NPI:1790762896
Name:UNITED MEDICAL REHABILITATION GROUP
Entity Type:Organization
Organization Name:UNITED MEDICAL REHABILITATION GROUP
Other - Org Name:WELLNESS PROVIDER USA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ONELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-345-8783
Mailing Address - Street 1:9300 NW 25TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1506
Mailing Address - Country:US
Mailing Address - Phone:305-471-0880
Mailing Address - Fax:305-471-7815
Practice Address - Street 1:9300 NW 25TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1506
Practice Address - Country:US
Practice Address - Phone:305-471-0880
Practice Address - Fax:305-471-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL684898261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684898Medicare ID - Type UnspecifiedCORF