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General NPI Number Information
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NPI Number | 1073526232
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Entity Type | Organization
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Legal Business Name | MIRISAN REHABILITATION INSTITUTE
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 7000 SW 97TH AVE SUITE 106
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City | MIAMI
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State | FL
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Zip | 33173-1494
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Country | US
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Telephone | 305-445-3944
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 SW 96 CT
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City | MIAMI
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State | FL
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Zip | 33165-6432
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Country | US
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Telephone | 305-273-0065
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANTIAGO PEDRO BELLO
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Credential | P.T.A
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Telephone | 305-445-3944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1786
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License Number State | FL
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