=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134205461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSIATRIC WELLNESS REHAB INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2006
-----------------------------------------------------
Last Update Date | 03/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13205 SW 137 AVE SUITE 126
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-256-9313
-----------------------------------------------------
Fax | 305-256-9347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13205 SW 137 AVE SUITE 126
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-256-9313
-----------------------------------------------------
Fax | 305-256-9347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | ANA V NOGAREDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-256-9313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------