=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689860280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI NEUROLOGY & REHABILITATION SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2007
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5975 SUNSET DR STE 405
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-8040
-----------------------------------------------------
Fax | 305-661-8891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5975 SUNSET DR STE 405
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-8040
-----------------------------------------------------
Fax | 305-661-8891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAROLYN MARTIN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 305-661-8040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204C00000X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------