Healthcare Provider Details

I. General information

NPI: 1508807371
Provider Name (Legal Business Name): 180 DEGREES REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 NW 36TH ST SUITE #113
VIRGINIA GARDENS FL
33166-6979
US

IV. Provider business mailing address

6595 NW 36TH ST SUITE #113
VIRGINIA GARDENS FL
33166-6979
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-9368
  • Fax: 305-871-9370
Mailing address:
  • Phone: 305-871-9368
  • Fax: 305-871-9370

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: MRS. RAFAELA MORERA ACOSTA
Title or Position: PRESIDENT
Credential:
Phone: 305-871-9368