Healthcare Provider Details

I. General information

NPI: 1871549881
Provider Name (Legal Business Name): SOUTH FLORIDA PAIN & REHABILITATION OF WEST BROWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 W OAKLAND PARK BLVD #101
TAMARAC FL
33319-4982
US

IV. Provider business mailing address

1814 NE MIAMI GARDENS DR #201
NORTH MIAMI BEACH FL
33179-5043
US

V. Phone/Fax

Practice location:
  • Phone: 954-746-2662
  • Fax: 954-746-2992
Mailing address:
  • Phone: 305-466-5665
  • Fax: 305-466-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8890
License Number StateFL

VIII. Authorized Official

Name: ALTHEA RIVAS-JOSEPH
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-466-5665