MEDICARE: PRO FITNESS AND REHAB

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	PT0006756	FL

General Provider Information

NPI Number	:	1558412650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO FITNESS AND REHAB

Provider Business Mailing Address
First Line	:	300 SEVILLA AVE
Second Line	:	SUITE# 304
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	305-968-1849
Fax Number	:	786-242-8269

Provider Business Practice Location Address
First Line	:	300 SEVILLA AVE
Second Line	:	SUITE# 304
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6636
Country	:	US
Telephone Number	:	305-968-1849
Fax Number	:	786-242-8269

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAVIER MARTIN PRO
Credential	:	PT
Telephone Number	:	305-968-1849

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/22/2020

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Directions to “PRO FITNESS AND REHAB ” Practice Location

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