MEDICARE: SOUTH BAY 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	261QR0400X	Rehabilitation Clinic/Center	06067989-45	FL

General Provider Information

NPI Number	:	1972543262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY REHAB

Provider Business Mailing Address
First Line	:	1850 SW 8 ST
Second Line	:	SUITE 302
City	:	MIAMI
State	:	FL
Zip	:	33135-3435
Country	:	US
Telephone Number	:	305-300-9241
Fax Number	:	305-541-6565

Provider Business Practice Location Address
First Line	:	12404 BISCAYNE BLVD
Second Line	:	SUITE B
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2521
Country	:	US
Telephone Number	:	305-300-9241
Fax Number	:	305-541-6565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEJANDRO MASSANI
Credential	:
Telephone Number	:	305-300-9241

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTH BAY REHAB ” Practice Location

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