Healthcare Provider Details

I. General information

NPI: 1215478854
Provider Name (Legal Business Name): PROFESSIONAL PHYSICAL REHABILITATION CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 107TH AVE 44
MIAMI FL
33165-2470
US

IV. Provider business mailing address

2500 SW 107TH AVE 44
MIAMI FL
33165-2470
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL A QUINTANA
Title or Position: PRESIDENT
Credential: LMT
Phone: 305-979-6178