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General NPI Number Information
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NPI Number | 1356630255
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Entity Type | Organization
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Legal Business Name | VISTA REHAB CENTER CORP
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 175 FONTAINEBLEAU BLVD STE 1G2
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City | MIAMI
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State | FL
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Zip | 33172-4511
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Country | US
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Telephone | 786-888-1097
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Fax | 786-888-1098
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Provider Business Mailing Address
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Address Line | 175 FONTAINEBLEAU BLVD. STE 1G-2
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City | MIAMI
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State | FLORIDA
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Zip | 33172
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Country | UM
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Telephone | 786-888-1097
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Fax | 786-888-1098
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Authorized Official
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Title or Position | MASSAGE THERAPY
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Name | ALFONSO M CASTENEDA
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Credential |
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Telephone | 786-888-1097
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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 | MA 52398
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License Number State | FL
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