Healthcare Provider Details

I. General information

NPI: 1285064790
Provider Name (Legal Business Name): FLORIDA INSTITUTE FOR PHYSICAL REHABILITATION, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1986 35TH AVE
VERO BEACH FL
32960-2533
US

IV. Provider business mailing address

PO BOX 411373
MELBOURNE FL
32941-1373
US

V. Phone/Fax

Practice location:
  • Phone: 772-360-4306
  • Fax: 772-380-4125
Mailing address:
  • Phone: 772-360-4306
  • Fax: 772-380-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME109841
License Number StateFL

VIII. Authorized Official

Name: DR. MIGUEL A RIVERA
Title or Position: OWNER
Credential: M.D.
Phone: 772-360-4306