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General NPI Number Information
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NPI Number | 1790713345
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Entity Type | Organization
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Legal Business Name | IMPERIAL THERAPY CENTER, INC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 2721 SW 137TH AVE SUITE 101
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City | MIAMI
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State | FL
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Zip | 33175-6355
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Country | US
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Telephone | 305-722-0787
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Fax | 786-237-0403
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Provider Business Mailing Address
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Address Line | 2721 SW 137TH AVE SUITE 101
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City | MIAMI
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State | FL
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Zip | 33175-6355
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Country | US
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Telephone | 305-722-0787
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Fax | 786-237-0403
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OLGA M HERNANDEZ
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Credential | CEO
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Telephone | 305-722-0787
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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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