MEDICARE: VISTA MEDICAL REHEB CENTER. 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	273Y00000X	Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1588085542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA MEDICAL REHEB CENTER. INC

Provider Business Mailing Address
First Line	:	4355 W 16TH AVE STE 212
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4355 W 16 AVE SUITE 212
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7670
Country	:	US
Telephone Number	:	786-487-1786
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS TRUTIE COUTIN
Credential	:	MT
Telephone Number	:	786-487-1786

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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