MEDICARE: PRIORITY MEDICAL 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	207Q00000X	Family Medicine Physician	HCC3713	FL

General Provider Information

NPI Number	:	1669550513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY MEDICAL REHAB

Provider Business Mailing Address
First Line	:	12781 SW 42ND ST STE B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3437
Country	:	US
Telephone Number	:	305-480-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	12781 SW 42ND ST STE B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3437
Country	:	US
Telephone Number	:	305-480-1111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANA VIVIAN NOGAREDA
Credential	:
Telephone Number	:	305-480-1111

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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