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General NPI Number Information
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NPI Number | 1013696574
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Entity Type | Organization
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Legal Business Name | BRAINWAVES REHABILITATION LLC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 9220 SW 167TH TER
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City | PALMETTO BAY
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State | FL
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Zip | 33157-3434
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Country | US
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Telephone | 305-450-9273
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Fax |
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Provider Business Mailing Address
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Address Line | 9220 SW 167TH TER
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City | PALMETTO BAY
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State | FL
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Zip | 33157-3434
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Country | US
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Telephone | 305-450-9273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YAHAIRA COLON
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Credential | M.S., CCC-SLP
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Telephone | 305-450-9273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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