Healthcare Provider Details

I. General information

NPI: 1295783454
Provider Name (Legal Business Name): IDEAL REHABILITATION INSTTUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W 49TH ST SUITE 126
HIALEAH FL
33012-2900
US

IV. Provider business mailing address

1800 W 49TH ST SUITE 126
HIALEAH FL
33012-2900
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-0036
  • Fax: 305-824-0008
Mailing address:
  • Phone: 305-824-0036
  • Fax: 305-824-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EVELYN CAPDEVILA
Title or Position: P
Credential:
Phone: 954-987-4747