Healthcare Provider Details

I. General information

NPI: 1134205461
Provider Name (Legal Business Name): PHYSIATRIC WELLNESS REHAB INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13205 SW 137 AVE SUITE 126
MIAMI FL
33186
US

IV. Provider business mailing address

13205 SW 137 AVE SUITE 126
MIAMI FL
33186
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-9313
  • Fax: 305-256-9347
Mailing address:
  • Phone: 305-256-9313
  • Fax: 305-256-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANA V NOGAREDA
Title or Position: OWNER PRESIDENT
Credential:
Phone: 305-256-9313