Healthcare Provider Details

I. General information

NPI: 1457365421
Provider Name (Legal Business Name): BE-WELL MEDICAL REHAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 TAFT ST SUITE 1004
HOLLYWOOD FL
33024-5962
US

IV. Provider business mailing address

6363 TAFT ST SUITE 1004
HOLLYWOOD FL
33024-5962
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-1303
  • Fax: 954-987-1355
Mailing address:
  • Phone: 786-663-1303
  • Fax: 954-987-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: IVAN PEREZ MOREIRA
Title or Position: PRESIDENT
Credential:
Phone: 786-663-1303