MEDICARE: DR B OUTPATIENT REHABILITATION CORP

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1215012612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR B OUTPATIENT REHABILITATION CORP

Provider Business Mailing Address
First Line	:	1131 NW 22ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2738
Country	:	US
Telephone Number	:	305-541-5011
Fax Number	:	305-541-5021

Provider Business Practice Location Address
First Line	:	1131 NW 22ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2738
Country	:	US
Telephone Number	:	305-541-5011
Fax Number	:	305-541-5021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMARA SUAREZ
Credential	:
Telephone Number	:	305-631-1550

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/22/2009

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