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General NPI Number Information
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NPI Number | 1194082909
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Entity Type | Organization
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Legal Business Name | PREMIER ATHLETIC REHAB CENTER LLC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 3121 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33134-6816
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Country | US
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Telephone | 305-396-9002
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Fax | 305-390-3003
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Provider Business Mailing Address
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Address Line | PO BOX 450844
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City | MIAMI
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State | FL
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Zip | 33245-0844
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Country | US
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Telephone | 305-396-9002
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Fax | 305-390-3003
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ALEJANDRO G GONZALEZ
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Credential | DPT
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Telephone | 305-282-7252
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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 | PT25977
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License Number State | FL
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