Provider Demographics
NPI:1255546784
Name:UNIVERSAL ARTS REHAB INC
Entity type:Organization
Organization Name:UNIVERSAL ARTS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:305-216-4321
Mailing Address - Street 1:8865 NW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6235
Mailing Address - Country:US
Mailing Address - Phone:305-216-4321
Mailing Address - Fax:305-274-0692
Practice Address - Street 1:1868 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4110
Practice Address - Country:US
Practice Address - Phone:305-216-4321
Practice Address - Fax:305-274-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ4081OtherLICENSE