MEDICARE: IDEAL REHABILITATION 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609834993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	1350 SW 57TH AVE
Second Line	:	SUITE 105
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5775
Country	:	US
Telephone Number	:	305-260-0188
Fax Number	:	305-260-0168

Provider Business Practice Location Address
First Line	:	1350 SW 57TH AVE
Second Line	:	SUITE 105
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5775
Country	:	US
Telephone Number	:	305-260-0188
Fax Number	:	305-260-0168

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YOEL GUTIERREZ PEREZ
Credential	:
Telephone Number	:	305-260-0188

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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