Healthcare Provider Details

I. General information

NPI: 1972719128
Provider Name (Legal Business Name): PHYSIOCORE FITNESS & REHAB., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SUNSET DRIVE
CORAL GABLES FL
11343-5642
US

IV. Provider business mailing address

1565 SUNSET DRIVE
CORAL GABLES FL
33143-5528
US

V. Phone/Fax

Practice location:
  • Phone: 786-271-3033
  • Fax: 305-668-9109
Mailing address:
  • Phone: 305-668-9108
  • Fax: 305-668-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18986
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number18986
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number18986
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number18986
License Number StateGA

VIII. Authorized Official

Name: MS. DORYS HERRERA
Title or Position: PRESIDENT
Credential: P.T.
Phone: 305-668-9108