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General NPI Number Information
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NPI Number | 1972521938
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL TECHNICIAN REHABILITATION CORP
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 42 NW 27TH AVE SUITE 323
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City | MIAMI
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State | FL
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Zip | 33125-5127
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Country | US
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Telephone | 305-642-0708
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Fax | 305-642-6989
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Provider Business Mailing Address
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Address Line | 42 NW 27TH AVE SUITE 323
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City | MIAMI
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State | FL
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Zip | 33125-5127
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Country | US
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Telephone | 305-642-0708
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Fax | 305-642-6989
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRACIELA RICARDO
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Credential |
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Telephone | 305-642-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | FL
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