=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992099626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDEEMED THERAPY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2011
-----------------------------------------------------
Last Update Date | 05/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3742 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-826-1180
-----------------------------------------------------
Fax | 305-826-1187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3742 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-826-1180
-----------------------------------------------------
Fax | 305-826-1187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HANCEL BAAMONDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-826-1180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | MA61953
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------