MEDICARE: PULMONARY PROVIDERS REHAB 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	293D00000X	Physiological Laboratory	RT5541 AND TN7986	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P09000000741	OTHER	FL	CORPORATION DOCUMENT NUMBER

General Provider Information

NPI Number	:	1790011716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY PROVIDERS REHAB INC.

Provider Business Mailing Address
First Line	:	1352 SW 75TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4422
Country	:	US
Telephone Number	:	305-266-4474
Fax Number	:	305-266-4474

Provider Business Practice Location Address
First Line	:	1352 SW 75TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4422
Country	:	US
Telephone Number	:	305-266-4474
Fax Number	:	305-266-4474

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. RAFAEL JORGE MENENDEZ
Credential	:
Telephone Number	:	305-266-4474

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	11/13/2009

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