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General NPI Number Information
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NPI Number | 1871997304
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Entity Type | Organization
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Legal Business Name | ABC THERAPY CENTER CORP.
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 959 SW 122ND AVE SUITE 959
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City | MIAMI
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State | FL
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Zip | 33184-2406
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Country | US
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Telephone | 305-649-0508
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Fax | 305-649-2145
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Provider Business Mailing Address
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Address Line | 959 SW 122ND AVE SUITE 959
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City | MIAMI
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State | FL
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Zip | 33184-2406
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Country | US
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Telephone | 305-649-0508
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Fax | 305-649-2145
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | IDALIA ACOSTA
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Credential | M.D.
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Telephone | 305-649-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME66961
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License Number State | FL
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