MEDICARE: KJ HEALTH THERAPY REHABILITATION, 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	207R00000X	Internal Medicine Physician	HCC7125	FL

General Provider Information

NPI Number	:	1255345013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ HEALTH THERAPY REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	3520 W 18TH AVE
Second Line	:	SUITE 115
City	:	HIALEAH
State	:	FL
Zip	:	33012-4634
Country	:	US
Telephone Number	:	305-823-0210
Fax Number	:	305-823-0096

Provider Business Practice Location Address
First Line	:	3520 W 18TH AVE
Second Line	:	SUITE 115
City	:	HIALEAH
State	:	FL
Zip	:	33012-4634
Country	:	US
Telephone Number	:	305-823-0210
Fax Number	:	305-823-0096

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SILVANA ZAMORA
Credential	:
Telephone Number	:	305-823-0210

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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