Healthcare Provider Details

I. General information

NPI: 1912765561
Provider Name (Legal Business Name): DELTA PERFORMANCE AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 172ND AVE
PEMBROKE PINES FL
33029-1517
US

IV. Provider business mailing address

8850 NW 151ST ST
MIAMI LAKES FL
33018-1320
US

V. Phone/Fax

Practice location:
  • Phone: 754-233-3907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HERNANDEZ
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 786-227-0752