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General NPI Number Information
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NPI Number | 1962876557
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Entity Type | Organization
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Legal Business Name | VIDA THERAPY INC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 9847 SW 184TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33157-6934
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Country | US
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Telephone | 786-227-6177
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Fax | 786-842-3608
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Provider Business Mailing Address
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Address Line | 11285 SW 211TH ST STE 207
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City | CUTLER BAY
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 786-227-6177
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Fax | 786-842-3608
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Authorized Official
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Title or Position | PRESIDENT
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Name | AYREMIS RODRIGUEZ
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Credential | MA
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Telephone | 786-227-6177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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