Healthcare Provider Details

I. General information

NPI: 1962737619
Provider Name (Legal Business Name): ORTHO REHAB OF HALLANDALE BCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N FEDERAL HWY UNIT 104
HALLANDALE BEACH FL
33009-4300
US

IV. Provider business mailing address

110 N FEDERAL HWY UNIT 104
HALLANDALE BEACH FL
33009-4300
US

V. Phone/Fax

Practice location:
  • Phone: 954-454-2870
  • Fax:
Mailing address:
  • Phone: 954-454-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. BROOKE A FLORES
Title or Position: GM
Credential:
Phone: 954-454-2870