=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760753792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S & Y REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2012
-----------------------------------------------------
Last Update Date | 01/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7495 SW 12TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-975-4159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7495 SW 12TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-5356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-975-4159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | P
-----------------------------------------------------
Name | YOSBANY ALFONSO
-----------------------------------------------------
Credential | MA62724
-----------------------------------------------------
Telephone | 786-975-4159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | MA62724
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------