MEDICARE: DYNAMIC REHAB SERVICE

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

General Provider Information

NPI Number	:	1457330524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC REHAB SERVICE

Provider Business Mailing Address
First Line	:	1840 W 49TH ST
Second Line	:	STE 304
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-557-0333
Fax Number	:	305-557-0302

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST
Second Line	:	STE 304
City	:	HIALEAH
State	:	FL
Zip	:	33012-2942
Country	:	US
Telephone Number	:	305-557-0333
Fax Number	:	305-557-0302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARLY CUETO
Credential	:
Telephone Number	:	305-557-0333

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	10/16/2007

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Directions to “DYNAMIC REHAB SERVICE ” Practice Location

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