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General NPI Number Information
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NPI Number | 1346585791
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Entity Type | Organization
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Legal Business Name | PALM REHAB CENTER
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 1275 W 47TH PL STE 422
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City | HIALEAH
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State | FL
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Zip | 33012-3452
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Country | US
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Telephone | 305-603-9956
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Fax | 305-456-8291
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Provider Business Mailing Address
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Address Line | 1275 W 47TH PL STE 422
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City | HIALEAH
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State | FL
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Zip | 33012-3452
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Country | US
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Telephone | 305-603-9956
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Fax | 305-456-8291
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Authorized Official
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Title or Position | OWNER
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Name | JOSE HERNANDEZ
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Credential |
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Telephone | 305-603-9956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC9062
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License Number State | FL
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