Healthcare Provider Details

I. General information

NPI: 1457275125
Provider Name (Legal Business Name): VITAL MEDICARE THERAPIST CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 S RED RD STE 104
MIAMI FL
33155-2164
US

IV. Provider business mailing address

1890 S RED RD STE 104
MIAMI FL
33155-2164
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4434
  • Fax: 786-359-4446
Mailing address:
  • Phone: 786-359-4434
  • Fax: 786-359-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BORIS DUARTE
Title or Position: OWNER
Credential:
Phone: 786-715-7432