Healthcare Provider Details

I. General information

NPI: 1013933191
Provider Name (Legal Business Name): SMITH PHYSICAL THERAPY REHABILITATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NW 36TH CT SUITE D
MIAMI FL
33125-4038
US

IV. Provider business mailing address

640 NW 36TH CT SUITE D
MIAMI FL
33125-4038
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8555
  • Fax: 305-671-3266
Mailing address:
  • Phone: 305-631-8555
  • Fax: 305-671-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME81313
License Number StateFL

VIII. Authorized Official

Name: MICHAEL PENA
Title or Position: PRESIDENT
Credential:
Phone: 305-631-8555