Healthcare Provider Details

I. General information

NPI: 1316550502
Provider Name (Legal Business Name): LYFE REHAB AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 NW 153RD ST STE 204
MIAMI LAKES FL
33014-2435
US

IV. Provider business mailing address

6175 NW 153RD ST STE 204
MIAMI LAKES FL
33014-2435
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-7260
  • Fax: 888-412-1788
Mailing address:
  • Phone: 786-536-7260
  • Fax: 888-412-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA REYES
Title or Position: MANAGER
Credential:
Phone: 786-536-7280