MEDICARE: THE PROFESSIONAL RE-HAB CENTER

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	207Q00000X	Family Medicine Physician
2	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1548270929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PROFESSIONAL RE-HAB CENTER

Provider Business Mailing Address
First Line	:	11373 W FLAGLER ST
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33174-4203
Country	:	US
Telephone Number	:	305-228-4545
Fax Number	:	305-228-4546

Provider Business Practice Location Address
First Line	:	11373 W FLAGLER ST
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33174-4203
Country	:	US
Telephone Number	:	305-228-4545
Fax Number	:	305-228-4546

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEINER CANCIO
Credential	:
Telephone Number	:	305-228-4545

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/18/2007

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Directions to “THE PROFESSIONAL RE-HAB CENTER ” Practice Location

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