MEDICARE: SOUTH MIAMI PAIN & REHAB CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1093718132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI PAIN & REHAB CENTER, INC

Provider Business Mailing Address
First Line	:	468 W 51ST PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3620
Country	:	US
Telephone Number	:	305-819-7770
Fax Number	:	954-473-0211

Provider Business Practice Location Address
First Line	:	468 W 51ST PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3620
Country	:	US
Telephone Number	:	305-819-7770
Fax Number	:	954-473-0211

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY DELACRUZ
Credential	:	DC
Telephone Number	:	305-819-7770

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/29/2009

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