Healthcare Provider Details

I. General information

NPI: 1598018400
Provider Name (Legal Business Name): REHAB & WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NW 42ND AVE SUITE 210
MIAMI FL
33126-5473
US

IV. Provider business mailing address

10 NW 42ND AVE SUITE 210
MIAMI FL
33126-5473
US

V. Phone/Fax

Practice location:
  • Phone: 305-476-9106
  • Fax: 305-476-9107
Mailing address:
  • Phone: 305-476-9106
  • Fax: 305-476-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH3300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA52337
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61381
License Number StateFL

VIII. Authorized Official

Name: SASHA FLORES
Title or Position: FRONT DESK
Credential:
Phone: 305-476-9106