Healthcare Provider Details

I. General information

NPI: 1568559706
Provider Name (Legal Business Name): SOUTH FLORIDA REHABILITATION & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 SW 117TH AVE SUITE 205
MIAMI FL
33183-3847
US

IV. Provider business mailing address

7990 SW 117TH AVE SUITE 205
MIAMI FL
33183-3847
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-7447
  • Fax: 305-271-7448
Mailing address:
  • Phone: 305-271-7447
  • Fax: 305-271-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. AIXA GOODRICH
Title or Position: P
Credential: DC
Phone: 305-271-7447