Healthcare Provider Details

I. General information

NPI: 1346293487
Provider Name (Legal Business Name): BIRD ROAD THERAPY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8362 SW 40TH ST
MIAMI FL
33155-3354
US

IV. Provider business mailing address

8362 SW 40TH ST
MIAMI FL
33155-3354
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-8166
  • Fax: 305-485-8468
Mailing address:
  • Phone: 305-480-8166
  • Fax: 305-485-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCC5739
License Number StateFL

VIII. Authorized Official

Name: FELIX J GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-480-8166