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General NPI Number Information
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NPI Number | 1396132148
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Entity Type | Organization
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Legal Business Name | PREMIUM REHAB SERVICES INC
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 12741 SW 42ND ST STE 121
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City | MIAMI
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State | FL
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Zip | 33175-3429
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Country | US
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Telephone | 305-389-0120
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Fax | 305-602-9351
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Provider Business Mailing Address
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Address Line | 12741 SW 42ND ST STE 121
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City | MIAMI
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State | FL
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Zip | 33175-3429
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Country | US
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Telephone | 305-389-0120
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Fax | 305-602-9351
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Authorized Official
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Title or Position | OWNER
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Name | JORGE L VALDEZ
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Credential |
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Telephone | 305-389-0120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | FL
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