MEDICARE: PEDIATRIC REHABILITATION CARE GROUP 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	227800000X	Certified Respiratory Therapist	RT9975	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	:	1790025971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC REHABILITATION CARE GROUP LLC

Provider Business Mailing Address
First Line	:	1840 W 49TH ST
Second Line	:	SUITE #604A
City	:	HIALEAH
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	786-488-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	786-488-4582
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GUSTAVO A GUERRA
Credential	:
Telephone Number	:	786-488-4582

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	03/07/2014

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