=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619266244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORAL NEW REHABILITATION CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 04/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6741 SW 24 ST SUITE 43
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-269-0999
-----------------------------------------------------
Fax | 305-269-0957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6741 SW 24 ST SUITE 43
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-269-0999
-----------------------------------------------------
Fax | 305-269-0957
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MASSAGE THERAPIST
-----------------------------------------------------
Name | EVILOY ROMERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-269-0999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | MA 60489
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------