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General NPI Number Information
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NPI Number | 1659386191
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Entity Type | Organization
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Legal Business Name | INFINITY REHAB CENTER INC.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 LESLIE DR APT 807
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7317
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Country | US
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Telephone | 954-304-0447
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LESLIE DR APT 807
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7317
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Country | US
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Telephone | 954-304-0447
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FERNANDO SOUTULLO
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Credential |
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Telephone | 786-306-0778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number |
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License Number State |
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