Provider Demographics
NPI:1831534577
Name:LAKES REHAB
Entity type:Organization
Organization Name:LAKES REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHET
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-929-8441
Mailing Address - Street 1:5803 NW 151ST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2473
Mailing Address - Country:US
Mailing Address - Phone:305-929-8450
Mailing Address - Fax:305-827-4422
Practice Address - Street 1:5803 NW 151ST ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2473
Practice Address - Country:US
Practice Address - Phone:305-929-8450
Practice Address - Fax:305-827-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6514261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy