MEDICARE: WEST FLAGLER MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1124835756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FLAGLER MEDICAL INC

Provider Business Mailing Address
First Line	:	85 GRAND CANAL DR STE 408
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2571
Country	:	US
Telephone Number	:	786-949-4747
Fax Number	:	786-949-4755

Provider Business Practice Location Address
First Line	:	85 GRAND CANAL DR STE 408
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2571
Country	:	US
Telephone Number	:	786-949-4747
Fax Number	:	786-949-4755

Authorized Official
Title or Position	:	CEO
Name	:	MAXIMO H ALFONSO GARCIA
Credential	:
Telephone Number	:	786-949-4747

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/17/2024

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