Healthcare Provider Details

I. General information

NPI: 1760590996
Provider Name (Legal Business Name): SOUTH MIAMI SPORTMEDICINE & HAND THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62 AVE #120
MIAMI FL
33143
US

IV. Provider business mailing address

7000 SW 62 AVE #120
MIAMI FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-7116
  • Fax: 305-666-7168
Mailing address:
  • Phone: 305-666-7116
  • Fax: 305-666-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT ALAN MILLARES
Title or Position: PRESIDENT OWNER
Credential: OTRL CHT
Phone: 305-666-7116