Provider Demographics
NPI:1962482034
Name:ACTIVE REHAB SERVICE, INC.
Entity Type:Organization
Organization Name:ACTIVE REHAB SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-595-0345
Mailing Address - Street 1:10250 SW 56TH ST
Mailing Address - Street 2:STE B103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7069
Mailing Address - Country:US
Mailing Address - Phone:305-595-0345
Mailing Address - Fax:305-595-0334
Practice Address - Street 1:10250 SW 56TH ST
Practice Address - Street 2:STE B103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7069
Practice Address - Country:US
Practice Address - Phone:305-595-0345
Practice Address - Fax:305-595-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2883225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684512Medicare ID - Type Unspecified