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General NPI Number Information
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NPI Number | 1255634416
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Entity Type | Organization
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Legal Business Name | EPM THERAPEUTIC CENTER I.N.C.
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 4445 W 16TH AVE STE 314
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City | HIALEAH
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State | FL
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Zip | 33012-7189
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Country | US
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Telephone | 305-640-5977
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 WEST16TH AVE STE 314
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-640-5977
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYDIA POWER
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Credential |
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Telephone | 305-640-5977
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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 | MM25898
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License Number State | FL
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