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General NPI Number Information
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NPI Number | 1962108258
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Entity Type | Organization
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Legal Business Name | REHAB LAB DAVIE
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 4801 SW 148TH AVE
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City | DAVIE
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State | FL
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Zip | 33330-2129
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Country | US
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Telephone | 954-804-2865
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Fax |
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Provider Business Mailing Address
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Address Line | 13225 SW 88TH AVE
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City | MIAMI
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State | FL
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Zip | 33176-5935
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Country | US
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Telephone | 954-804-2865
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Fax |
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Authorized Official
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Title or Position | OWNER AND DIRECTOR OF OPERATIONS
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Name | MR. ENRIQUE GOMEZ
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Credential |
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Telephone | 786-879-4209
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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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