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General NPI Number Information
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NPI Number | 1265485981
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Entity Type | Organization
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Legal Business Name | SOUTH BROWARD REHABILITATON
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1570 W 38TH PL STE 3 & 4
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City | HIALEAH
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State | FL
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Zip | 33012-7012
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Country | US
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Telephone | 305-698-0096
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Fax | 305-698-0098
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Provider Business Mailing Address
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Address Line | 1570 W 38TH PL STE 3 & 4
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City | HIALEAH
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State | FL
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Zip | 33012-7012
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Country | US
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Telephone | 305-698-0096
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Fax | 305-698-0098
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Authorized Official
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Title or Position | OWNER
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Name | JESUS GARCIA
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Credential |
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Telephone | 305-698-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 541102-0
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License Number State | FL
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