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General NPI Number Information
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NPI Number | 1922617323
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Entity Type | Organization
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Legal Business Name | BLUE DIAMON REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 4485 STIRLING RD STE 110
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City | DAVIE
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State | FL
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Zip | 33314-7517
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Country | US
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Telephone | 786-954-2954
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Fax |
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Provider Business Mailing Address
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Address Line | 4485 STIRLING RD STE 110
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City | DAVIE
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State | FL
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Zip | 33314-7517
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Country | US
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Telephone | 786-954-2954
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Fax |
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Authorized Official
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Title or Position | OWNWER
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Name | ANTONIO LOPEZ
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Credential |
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Telephone | 305-432-6989
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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 |
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License Number State |
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