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General NPI Number Information
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NPI Number | 1699967406
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Entity Type | Organization
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Legal Business Name | SPECIALTY MEDICAL INC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 3750 W 16TH AVE SUITE 238 U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-698-1895
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Fax | 305-698-1897
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Provider Business Mailing Address
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Address Line | 3750 W 16TH AVE SUITE 238 U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-698-1895
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Fax | 305-698-1897
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Authorized Official
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Title or Position | OWNER
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Name | MR. SERGIO SHELTON
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Credential |
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Telephone | 305-698-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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