=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093533721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVY SOUTH FLORIDA MEDICAL CENTER CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2024
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2711 SW 137TH AVE STE 94
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-951-9551
-----------------------------------------------------
Fax | 786-936-5591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2711 SW 137TH AVE STE 94
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-951-9551
-----------------------------------------------------
Fax | 786-936-5591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSE L SANCHEZ BENITEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-951-9551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------