MEDICARE: CW PHYSICAL REHAB 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1710302310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CW PHYSICAL REHAB CENTER INC

Provider Business Mailing Address
First Line	:	2450 SW 137TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6312
Country	:	US
Telephone Number	:	786-703-2654
Fax Number	:	786-703-2654

Provider Business Practice Location Address
First Line	:	2450 SW 137TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6312
Country	:	US
Telephone Number	:	786-703-2654
Fax Number	:	786-703-2654

Authorized Official
Title or Position	:	OWNER
Name	:	ZUREY MARTIN
Credential	:	LMT
Telephone Number	:	786-218-4440

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/27/2014

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