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General NPI Number Information
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NPI Number | 1306134374
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Entity Type | Organization
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Legal Business Name | BLUE MILLENIUM REHABILITATION, INC.
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 7911 NW 72ND AVE STE 103B
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City | MEDLEY
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State | FL
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Zip | 33166-2226
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Country | US
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Telephone | 305-456-7798
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 NW 72ND AVE STE 103B
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City | MEDLEY
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State | FL
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Zip | 33166-2226
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Country | US
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Telephone | 305-456-7798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JUAN FERNANDO LOPEZ
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Credential | L.M.T
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Telephone | 30054567798
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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 | MM27251
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License Number State |
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