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General NPI Number Information
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NPI Number | 1730467515
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Entity Type | Organization
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Legal Business Name | PREMIER THERAPY AND REHABILITATION GROUP INC
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 2100 W 76TH ST SUITE 209
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City | HIALEAH
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State | FL
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Zip | 33016-5539
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Country | US
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Telephone | 786-691-3708
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Fax | 305-671-3306
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Provider Business Mailing Address
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Address Line | 2100 W 76TH ST SUITE 209
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City | HIALEAH
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State | FL
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Zip | 33016-5539
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Country | US
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Telephone | 786-691-3708
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Fax | 305-671-3306
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Authorized Official
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Title or Position | PRESIDENT
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Name | INGRISS TRAVIESO
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Credential | LMT
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Telephone | 786-691-3708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MM27332
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License Number State | FL
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