Provider Demographics
NPI:1700101912
Name:MIAMI LAKES THERAPY CENTER, INC
Entity Type:Organization
Organization Name:MIAMI LAKES THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:305-790-0223
Mailing Address - Street 1:6073 NW 167TH ST
Mailing Address - Street 2:C13
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4336
Mailing Address - Country:US
Mailing Address - Phone:305-362-5328
Mailing Address - Fax:305-362-3303
Practice Address - Street 1:6073 NW 167TH ST
Practice Address - Street 2:C13
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4336
Practice Address - Country:US
Practice Address - Phone:305-362-5328
Practice Address - Fax:305-362-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225800000X, 225X00000X, 261QH0700X
FLSA9388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty