MEDICARE: MIAMI SCI WELLNESS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16224	OTHER	FL	AGENCY FOR HEALTH CARE ADMINISTRATION LICENSE

General Provider Information

NPI Number	:	1396400289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI SCI WELLNESS, INC

Provider Business Mailing Address
First Line	:	14241 SW 120TH ST STE 107
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7240
Country	:	US
Telephone Number	:	305-283-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	14241 SW 120TH ST STE 107
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7240
Country	:	US
Telephone Number	:	305-283-9717
Fax Number	:	786-431-1347

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MORGAN GONZALEZ
Credential	:	DPT
Telephone Number	:	305-283-9717

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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Directions to “MIAMI SCI WELLNESS, INC ” Practice Location

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