MEDICARE: KREATIVE THERAPY & 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	174400000X	Specialist

General Provider Information

NPI Number	:	1174842801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREATIVE THERAPY & REHAB CENTER, INC

Provider Business Mailing Address
First Line	:	17300 NW 68TH AVE
Second Line	:	117
City	:	HIALEAH
State	:	FL
Zip	:	33015-4014
Country	:	US
Telephone Number	:	786-319-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	17300 NW 68TH AVE
Second Line	:	117
City	:	HIALEAH
State	:	FL
Zip	:	33015-4014
Country	:	US
Telephone Number	:	786-319-0848
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIGUEL MENDEZ
Credential	:
Telephone Number	:	786-319-0848

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/20/2010

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