Healthcare Provider Details

I. General information

NPI: 1619397965
Provider Name (Legal Business Name): REHABILITATION OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 E 25TH ST
HIALEAH FL
33013-3703
US

IV. Provider business mailing address

1033 E 25TH ST
HIALEAH FL
33013-3703
US

V. Phone/Fax

Practice location:
  • Phone: 305-691-5384
  • Fax: 305-835-2894
Mailing address:
  • Phone: 305-691-5384
  • Fax: 305-835-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 19177
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 10382
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM LOPEZ
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 305-691-5384