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General NPI Number Information
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NPI Number | 1669837753
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Entity Type | Organization
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Legal Business Name | PHYSICAL OCCUPATIONAL AND SPORT REHABILITATION CENTER
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 1830 NW 7TH ST STE 201
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City | MIAMI
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State | FL
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Zip | 33125-3569
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Country | US
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Telephone | 786-287-5041
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 NW 7TH ST STE 201
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City | MIAMI
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State | FL
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Zip | 33125-3569
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Country | US
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Telephone | 786-287-5041
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESUS ALFONSO
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Credential |
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Telephone | 786-287-5041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 23100
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License Number State | FL
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