Healthcare Provider Details

I. General information

NPI: 1154370831
Provider Name (Legal Business Name): LA SCALA REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8360 SW 40TH ST
MIAMI FL
33155-3354
US

IV. Provider business mailing address

8360 SW 40 STREET
MIAMI FL
33155-3354
US

V. Phone/Fax

Practice location:
  • Phone: 305-485-9847
  • Fax: 305-485-9850
Mailing address:
  • Phone: 305-485-9847
  • Fax: 305-485-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberOT10841
License Number StateFL

VIII. Authorized Official

Name: MS. JUSTA DAVILA
Title or Position: PRESIDENT
Credential: CNA
Phone: 305-485-9847