Healthcare Provider Details

I. General information

NPI: 1629372438
Provider Name (Legal Business Name): WEST KENDALL REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE SUITE # 103
MIAMI FL
33193-5826
US

IV. Provider business mailing address

8785 SW 165TH AVE SUITE # 103
MIAMI FL
33193-5826
US

V. Phone/Fax

Practice location:
  • Phone: 786-401-6775
  • Fax: 786-401-6779
Mailing address:
  • Phone: 786-401-6775
  • Fax: 786-401-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOMINGO PEREZ
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 786-401-6775