MEDICARE: RECONNECT THERAPY SERVICES, 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487246252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECONNECT THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	9426 SW 146TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9426 SW 146TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1073
Country	:	US
Telephone Number	:	305-900-3787
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVELYN PINTO-CARDONA
Credential	:
Telephone Number	:	305-900-3787

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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