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General NPI Number Information
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NPI Number | 1518666494
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Entity Type | Organization
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Legal Business Name | VA PHYSICAL REHABILITATION CORP
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 974 OLD DIXIE HWY STE A
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City | HOMESTEAD
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State | FL
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Zip | 33030-4933
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Country | US
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Telephone | 305-778-6071
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Fax | 786-292-2842
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Provider Business Mailing Address
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Address Line | 974 OLD DIXIE HWY STE A
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City | HOMESTEAD
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State | FL
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Zip | 33030-4933
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Country | US
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Telephone | 305-778-6071
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Fax | 786-292-2842
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. JUAN I VALLES
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Credential |
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Telephone | 305-778-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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