MEDICARE: M & J REHAB SERVICE 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	261QP2000X	Physical Therapy Clinic/Center	MA62218	FL

General Provider Information

NPI Number	:	1891078853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & J REHAB SERVICE INC.

Provider Business Mailing Address
First Line	:	930 NW 123RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-2411
Country	:	US
Telephone Number	:	786-299-5329
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 NW 123RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-2411
Country	:	US
Telephone Number	:	786-299-5329
Fax Number	:

Authorized Official
Title or Position	:	C E O
Name	:	NOELIO H HERRERA
Credential	:
Telephone Number	:	786-299-5329

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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