Healthcare Provider Details

I. General information

NPI: 1245517275
Provider Name (Legal Business Name): MT THERAPY & REHAB SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SW 6TH ST APT 10
MIAMI FL
33135-3249
US

IV. Provider business mailing address

2120 SW 6TH ST APT 10
MIAMI FL
33135-3249
US

V. Phone/Fax

Practice location:
  • Phone: 786-537-4435
  • Fax:
Mailing address:
  • Phone: 786-537-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMA62359
License Number StateFL

VIII. Authorized Official

Name: MAYDEL MIRANDA TOLEDO
Title or Position: PT
Credential:
Phone: 786-537-4435