Healthcare Provider Details

I. General information

NPI: 1518305986
Provider Name (Legal Business Name): HIGHLAND THERAPEUTIC CENTER, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 SW 24TH ST SUITE # 127
MIAMI FL
33155-6539
US

IV. Provider business mailing address

175 FONTAINEBLEAU BLVD SUITE 1-C
MIAMI FL
33172-7012
US

V. Phone/Fax

Practice location:
  • Phone: 786-319-2984
  • Fax:
Mailing address:
  • Phone: 305-138-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHCC10576
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUAN SANTANA
Title or Position: PRESIDENT
Credential:
Phone: 786-391-2984