Healthcare Provider Details

I. General information

NPI: 1962079814
Provider Name (Legal Business Name): HEALING REHABILITATION CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 COMMERCE WAY STE 206
MIAMI LAKES FL
33016-1598
US

IV. Provider business mailing address

14411 COMMERCE WAY STE 206
MIAMI LAKES FL
33016-1598
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-3454
  • Fax:
Mailing address:
  • Phone: 786-409-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FREDDY MARINO LEYVA
Title or Position: PRESIDENT
Credential:
Phone: 786-409-3454