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General NPI Number Information
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NPI Number | 1013211705
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Entity Type | Organization
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Legal Business Name | SOUTH MIAMI SPORTS MEDICINE INC.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 7000 SW 62ND AVE SUITE 120
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4716
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Country | US
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Telephone | 305-666-7168
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 S.W. 62 AVENUE SUITE 120
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City | MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 305-666-7168
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ROBERT A MILLARES
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Credential | OTRL,CHT
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Telephone | 305-666-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | OT2468
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License Number State | FL
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