MEDICARE: SOUTH BROWARD REHABILITATON

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	225400000X	Rehabilitation Practitioner	541102-0	FL

General Provider Information

NPI Number	:	1265485981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BROWARD REHABILITATON

Provider Business Mailing Address
First Line	:	1570 W 38TH PL
Second Line	:	STE 3 & 4
City	:	HIALEAH
State	:	FL
Zip	:	33012-7012
Country	:	US
Telephone Number	:	305-698-0096
Fax Number	:	305-698-0098

Provider Business Practice Location Address
First Line	:	1570 W 38TH PL
Second Line	:	STE 3 & 4
City	:	HIALEAH
State	:	FL
Zip	:	33012-7012
Country	:	US
Telephone Number	:	305-698-0096
Fax Number	:	305-698-0098

Authorized Official
Title or Position	:	OWNER
Name	:	JESUS GARCIA
Credential	:
Telephone Number	:	305-698-0096

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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