Healthcare Provider Details

I. General information

NPI: 1144459900
Provider Name (Legal Business Name): COMPLETE THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 NW 27TH AVE
MIAMI FL
33125-3031
US

IV. Provider business mailing address

352 NW 27TH AVE
MIAMI FL
33125-3031
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-6711
  • Fax: 305-646-6712
Mailing address:
  • Phone: 305-646-6711
  • Fax: 305-646-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberCH8101
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMM23361
License Number StateFL

VIII. Authorized Official

Name: MR. EMERSON RUIZ ECHEVARRIA
Title or Position: OWNER
Credential:
Phone: 786-474-8564