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General NPI Number Information
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NPI Number | 1780627059
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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 | 06/14/2006
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 729 E 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-1965
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Country | US
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Telephone | 305-389-5506
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Fax | 305-389-5506
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Provider Business Mailing Address
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Address Line | 729 E 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-1965
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Country | US
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Telephone | 305-389-5506
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Fax | 305-389-5506
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. SERGIO SHELTON
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Credential |
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Telephone | 305-389-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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