Healthcare Provider Details

I. General information

NPI: 1912824152
Provider Name (Legal Business Name): G&R KIDS THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15346 NW 79TH CT
MIAMI LAKES FL
33016-5850
US

IV. Provider business mailing address

15346 NW 79TH CT
MIAMI LAKES FL
33016-5850
US

V. Phone/Fax

Practice location:
  • Phone: 786-477-3620
  • Fax:
Mailing address:
  • Phone: 786-477-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL NICOLAS RODRIGUEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 786-999-5773