Provider Demographics
NPI:1205301942
Name:PHOENIX REHAB CENTER CORP
Entity type:Organization
Organization Name:PHOENIX REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-841-6797
Mailing Address - Street 1:8500 W FLAGLER ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2063
Mailing Address - Country:US
Mailing Address - Phone:786-703-2917
Mailing Address - Fax:786-703-2945
Practice Address - Street 1:8500 W FLAGLER ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2063
Practice Address - Country:US
Practice Address - Phone:786-703-2917
Practice Address - Fax:786-703-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty