=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710296652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C.D.C REHABILITATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 09/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 SW 8TH ST STE 200
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-8576
-----------------------------------------------------
Fax | 305-456-8784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 SW 8TH ST STE 200
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-8576
-----------------------------------------------------
Fax | 305-456-8784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPY
-----------------------------------------------------
Name | LARISA BERMEJO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-456-8579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number | MM25550
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------