MEDICARE: SOUTH MIAMI REHABILITATION, 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)	683224	FL

General Provider Information

NPI Number	:	1255318333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	8390 W FLAGLER ST
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33144-2039
Country	:	US
Telephone Number	:	305-480-5688
Fax Number	:	305-480-5680

Provider Business Practice Location Address
First Line	:	8390 W FLAGLER ST
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33144-2039
Country	:	US
Telephone Number	:	305-480-5688
Fax Number	:	305-480-5680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUAN MANZANO
Credential	:
Telephone Number	:	786-237-9720

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/18/2007

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