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General NPI Number Information
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NPI Number | 1841577061
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Entity Type | Organization
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Legal Business Name | COMPLETE REHABILITATION & MASSAGE CENTER INC.
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 12060 SW 129TH CT SUITE 207
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City | MIAMI
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State | FL
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Zip | 33186-4581
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Country | US
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Telephone | 786-273-2884
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Fax |
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Provider Business Mailing Address
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Address Line | 12060 SW 129 CT ST SUITE 207
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City | MIAMI
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State | FL
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Zip | 33186
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Country | US
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Telephone | 786-273-2884
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. REYNALDO DIAZ
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Credential |
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Telephone | 305-370-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA 56602
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License Number State | FL
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