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General NPI Number Information
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NPI Number | 1336455435
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Entity Type | Organization
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Legal Business Name | CORA
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 1893 NE MIAMI GARDENS DR
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-5035
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Country | US
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Telephone | 305-682-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 19501 E COUNTRY CLUB DR #9304
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City | AVENTURA
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State | FL
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Zip | 33180-2551
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Country | US
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Telephone | 954-790-2186
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | MR. JAVIER OTHON
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Credential | P.T.
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Telephone | 305-479-7593
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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 | PT25769
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License Number State | FL
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