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General NPI Number Information
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NPI Number | 1659656114
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Entity Type | Organization
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Legal Business Name | ADVANCED MASSAGE THERAPY REHAB CORP
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 5800 SW 17TH ST
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City | MIAMI
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State | FL
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Zip | 33155-2121
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Country | US
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Telephone | 786-239-7345
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 SW 17 ST
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 786-239-7345
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REBECA BERRA
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Credential | LMT
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Telephone | 786-239-7345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | MA50653
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License Number State | FL
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