Provider Demographics
NPI:1982741690
Name:NEUROMUSCULAR THERAPY OF SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:NEUROMUSCULAR THERAPY OF SOUTH FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAVILANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-596-4876
Mailing Address - Street 1:9425 SW 72ND ST STE 186
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3298
Mailing Address - Country:US
Mailing Address - Phone:305-596-4876
Mailing Address - Fax:305-596-4861
Practice Address - Street 1:9425 SW 72ND ST STE 186
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3298
Practice Address - Country:US
Practice Address - Phone:305-596-4876
Practice Address - Fax:305-596-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y903NOtherBCBS
R5AOtherBCBS FEP
FL106853Medicare ID - Type Unspecified