Provider Demographics
NPI:1356630255
Name:VISTA REHAB CENTER CORP
Entity type:Organization
Organization Name:VISTA REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTENEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-888-1097
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD. STE 1G-2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:33172
Mailing Address - Country:UM
Mailing Address - Phone:786-888-1097
Mailing Address - Fax:786-888-1098
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 1G2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4511
Practice Address - Country:US
Practice Address - Phone:786-888-1097
Practice Address - Fax:786-888-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 52398261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy