Healthcare Provider Details

I. General information

NPI: 1831534577
Provider Name (Legal Business Name): LAKES REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 NW 151ST ST STE 107
MIAMI LAKES FL
33014-2473
US

IV. Provider business mailing address

5803 NW 151ST ST STE 107
MIAMI LAKES FL
33014-2473
US

V. Phone/Fax

Practice location:
  • Phone: 305-929-8450
  • Fax: 305-827-4422
Mailing address:
  • Phone: 305-929-8450
  • Fax: 305-827-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberHCC6514
License Number StateFL

VIII. Authorized Official

Name: MR. RICHET CUNILL
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 305-929-8441