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NPI Code Detail

MEDICARE: SHAKE-A-LEG MIAMI INC

MEDICARE: SHAKE-A-LEG MIAMI 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
1261QD1600XDevelopmental Disabilities Clinic/Center
2261QR0400XRehabilitation Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1740500503
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKE-A-LEG MIAMI INC
Provider Business Mailing Address
First Line : 2620 S BAYSHORE DR
Second Line :
City : MIAMI
State : FL
Zip : 33133-5424
Country : US
Telephone Number : 305-858-5550
Fax Number :
Provider Business Practice Location Address
First Line : 2620 S BAYSHORE DR
Second Line :
City : MIAMI
State : FL
Zip : 33133-5424
Country : US
Telephone Number : 305-858-5550
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. HARRY HORGAN
Credential :
Telephone Number : 305-858-5550
Provider Enumeration Date : 06/03/2010
Last Update Date : 06/03/2010

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Directions to “SHAKE-A-LEG MIAMI INC ” Practice Location

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