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General NPI Number Information
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NPI Number | 1245505445
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Entity Type | Organization
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Legal Business Name | ODA REHABILITATION SERVICE, INC.
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 641 W 50TH PL
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City | HIALEAH
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State | FL
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Zip | 33012-3614
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Country | US
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Telephone | 786-231-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 641 W 50TH PL
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City | HIALEAH
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State | FL
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Zip | 33012-3614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ODALYS L. TORMO DE SERRANO
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Credential | LMT
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Telephone | 786-231-9770
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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 | MA32059
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License Number State | FL
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