Provider Demographics
NPI:1659656114
Name:ADVANCED MASSAGE THERAPY REHAB CORP
Entity type:Organization
Organization Name:ADVANCED MASSAGE THERAPY REHAB CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-239-7345
Mailing Address - Street 1:5800 SW 17 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:786-239-7345
Mailing Address - Fax:
Practice Address - Street 1:5800 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2121
Practice Address - Country:US
Practice Address - Phone:786-239-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50653261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation