Healthcare Provider Details

I. General information

NPI: 1891096525
Provider Name (Legal Business Name): THERAPY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 NW 72TH AVE #113
MIAMI FL
33122
US

IV. Provider business mailing address

2550 NW 72 AVE #113
MIAMI FL
33122
US

V. Phone/Fax

Practice location:
  • Phone: 786-581-5963
  • Fax: 786-472-8119
Mailing address:
  • Phone: 786-581-5963
  • Fax: 786-472-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberHCC8739
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOHENDY BARO
Title or Position: PRESIDENT
Credential: PT
Phone: 786-581-5963