Provider Demographics
NPI:1013989680
Name:C & G REHAB SERV CORP
Entity type:Organization
Organization Name:C & G REHAB SERV CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARQUIMIDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-6585
Mailing Address - Street 1:7911 NW 72ND AVE
Mailing Address - Street 2:STE 118A
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-863-6585
Mailing Address - Fax:305-863-6583
Practice Address - Street 1:7911 NW 72ND AVE
Practice Address - Street 2:STE 118A
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-863-6585
Practice Address - Fax:305-863-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
686706Medicare ID - Type Unspecified