Healthcare Provider Details

I. General information

NPI: 1235335423
Provider Name (Legal Business Name): TOTAL CHOICE MEDICAL AND REHAB CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 W 60TH ST STE 204
HIALEAH FL
33016-2692
US

IV. Provider business mailing address

2189 W 60TH ST STE 204
HIALEAH FL
33016-2692
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-4861
  • Fax: 305-827-4821
Mailing address:
  • Phone: 305-827-4861
  • Fax: 305-827-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC7530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number616039-4
License Number StateFL

VIII. Authorized Official

Name: PAUL GUADAGNO
Title or Position: OWNER
Credential:
Phone: 305-827-4861