Healthcare Provider Details

I. General information

NPI: 1972599413
Provider Name (Legal Business Name): GALLOWAY REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 NW 7TH ST
MIAMI FL
33126-2307
US

IV. Provider business mailing address

4530 NW 7TH ST
MIAMI FL
33126-2307
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-1449
  • Fax: 305-444-0387
Mailing address:
  • Phone: 305-444-1449
  • Fax: 305-444-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number4974
License Number StateFL

VIII. Authorized Official

Name: MRS. ILSE E PRADO
Title or Position: PRESIDENT
Credential:
Phone: 305-444-1449