MEDICARE: MIAMI GARDENS PHYSICAL THERAPY AND REHAB CENTER, LLC

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	174400000X	Specialist	PT4649	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104208032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI GARDENS PHYSICAL THERAPY AND REHAB CENTER, LLC

Provider Business Mailing Address
First Line	:	2259 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4638
Country	:	US
Telephone Number	:	786-318-8470
Fax Number	:

Provider Business Practice Location Address
First Line	:	2259 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4638
Country	:	US
Telephone Number	:	786-318-8470
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. SHALAINE MURRAY
Credential	:
Telephone Number	:	305-952-3139

Provider Enumeration Date	:	06/27/2015
Last Update Date	:	02/19/2025

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