MEDICARE: BIO-MEDICAL REHABILITATION AND WELLNESS

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1588125744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO-MEDICAL REHABILITATION AND WELLNESS

Provider Business Mailing Address
First Line	:	9905 NW 79TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2405
Country	:	US
Telephone Number	:	305-205-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	9905 NW 79TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2405
Country	:	US
Telephone Number	:	305-205-6161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOMINICK MAURICI
Credential	:	PTA
Telephone Number	:	305-205-6161

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	06/11/2019

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