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General NPI Number Information
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NPI Number | 1740500503
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Entity Type | Organization
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Legal Business Name | SHAKE-A-LEG MIAMI INC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 2620 S BAYSHORE DR
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City | MIAMI
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State | FL
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Zip | 33133-5424
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Country | US
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Telephone | 305-858-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 S BAYSHORE DR
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City | MIAMI
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State | FL
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Zip | 33133-5424
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Country | US
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Telephone | 305-858-5550
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. HARRY HORGAN
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Credential |
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Telephone | 305-858-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities 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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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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