=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134117112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABLES REHABILITATION SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 01/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 NW 21ST CT STE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-644-4201
-----------------------------------------------------
Fax | 305-644-3339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 NW 21ST CT STE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-644-4201
-----------------------------------------------------
Fax | 305-644-3339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR ASSISTANT
-----------------------------------------------------
Name | MRS. JANET MESA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-644-4201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | PO5000132512
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------