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General NPI Number Information
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NPI Number | 1205394392
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Entity Type | Organization
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Legal Business Name | PREMIUM REHABILITATION OF MIAMI INC
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 530 W 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3605
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Country | US
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Telephone | 305-497-2239
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Fax |
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Provider Business Mailing Address
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Address Line | 590 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33135-2906
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Country | US
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Telephone | 305-987-0807
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARILYN HAWKINS
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Credential |
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Telephone | 305-495-1622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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