Healthcare Provider Details

I. General information

NPI: 1578098737
Provider Name (Legal Business Name): MIAMI NEUROLOGY & REHABILITATION SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 SUNSET DR SUITE 405
SOUTH MIAMI FL
33143-5166
US

IV. Provider business mailing address

5975 SUNSET DR SUITE 405
SOUTH MIAMI FL
33143-5166
US

V. Phone/Fax

Practice location:
  • Phone: 786-532-3560
  • Fax:
Mailing address:
  • Phone: 305-661-8040
  • Fax: 305-661-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberCH9730
License Number StateFL

VIII. Authorized Official

Name: NICHOLAS GAZO
Title or Position: PRESIDENT
Credential:
Phone: 786-532-3560