Healthcare Provider Details

I. General information

NPI: 1255487807
Provider Name (Legal Business Name): ULTIMATE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 NE MIAMI GARDENS DR
N MIAMI BEACH FL
33179-5301
US

IV. Provider business mailing address

1770 NE MIAMI GARDENS DR
N MIAMI BEACH FL
33179-5301
US

V. Phone/Fax

Practice location:
  • Phone: 305-944-8290
  • Fax: 305-944-8061
Mailing address:
  • Phone: 305-944-8290
  • Fax: 305-944-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15284
License Number StateFL

VIII. Authorized Official

Name: MARISELA GONZALEZ
Title or Position: PRESIDENT
Credential: PT
Phone: 305-944-8290