Provider Demographics
NPI:1205309275
Name:GENTLE REHAB INC
Entity type:Organization
Organization Name:GENTLE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:JELINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-310-0247
Mailing Address - Street 1:12440 KEYSTONE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2421
Mailing Address - Country:US
Mailing Address - Phone:305-310-0247
Mailing Address - Fax:305-378-6760
Practice Address - Street 1:15701 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6373
Practice Address - Country:US
Practice Address - Phone:305-200-8927
Practice Address - Fax:305-200-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0025847100Medicaid