MEDICARE: EXCELLENCE WELLNESS 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	261QM1300X	Multi-Specialty Clinic/Center	9581	FL

General Provider Information

NPI Number	:	1952644551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE WELLNESS REHAB CENTER, INC

Provider Business Mailing Address
First Line	:	5200 SW 8TH ST STE 201B
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2337
Country	:	US
Telephone Number	:	786-452-8071
Fax Number	:	786-452-8093

Provider Business Practice Location Address
First Line	:	5200 SW 8TH ST STE 201B
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2337
Country	:	US
Telephone Number	:	786-452-8071
Fax Number	:	786-452-8093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE SUAREZ
Credential	:	LMT
Telephone Number	:	786-452-8071

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/02/2013

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