Healthcare Provider Details

I. General information

NPI: 1124011069
Provider Name (Legal Business Name): THERA HEALTH REHAB CONSULTING MARKETING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SW 107TH AVE
MIAMI FL
33176-2760
US

IV. Provider business mailing address

10110 SW 107TH AVE
MIAMI FL
33176-2760
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-1099
  • Fax: 305-598-6673
Mailing address:
  • Phone: 305-598-1099
  • Fax: 305-598-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. IVETTE M LUENGO
Title or Position: PRESIDENT
Credential:
Phone: 305-598-1099