=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932635018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH FLORIDA RESTORE MOTION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2017
-----------------------------------------------------
Last Update Date | 04/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7760 W 20TH AVE SUITE 12
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-754-5240
-----------------------------------------------------
Fax | 786-610-1898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7760 W 20TH AVE SUITE 12
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-718-0531
-----------------------------------------------------
Fax | 786-610-1898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | DR. EMILIANO CURIA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 877-754-5240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | 1314235
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1314235
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------