Healthcare Provider Details

I. General information

NPI: 1326072208
Provider Name (Legal Business Name): T&R REHAB AND DIAGNOSTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 W 84TH STREET UNIT #110
HIALEAH FL
33018
US

IV. Provider business mailing address

3412 W 84TH STREET UNIT #110
HIALEAH FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-8889
  • Fax: 305-824-1511
Mailing address:
  • Phone: 305-821-8889
  • Fax: 305-824-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RUTH DEL CARMEN REVERON
Title or Position: PRESIDENT
Credential:
Phone: 305-821-8889