MEDICARE: NEW MILLENIUM REHABILITATION CENTER 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
2	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1275550204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MILLENIUM REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	5205 NW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-4824
Country	:	US
Telephone Number	:	305-418-4108
Fax Number	:	305-418-4081

Provider Business Practice Location Address
First Line	:	5205 NW 74TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-4824
Country	:	US
Telephone Number	:	305-418-4108
Fax Number	:	305-418-4081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EZEQUIEL CUELLO
Credential	:
Telephone Number	:	305-418-4108

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	01/06/2012

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