Provider Demographics
NPI:1912209628
Name:ALL FLORIDA REHABILITATION CENTER
Entity Type:Organization
Organization Name:ALL FLORIDA REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERNANDEZ-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-235-6164
Mailing Address - Street 1:8370 W FLAGLER ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2094
Mailing Address - Country:US
Mailing Address - Phone:786-235-6164
Mailing Address - Fax:786-235-6165
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE 222
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2094
Practice Address - Country:US
Practice Address - Phone:786-235-6164
Practice Address - Fax:786-235-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47191261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8741OtherAGENCY FOR HEALTH CARE