Provider Demographics
NPI:1063717031
Name:VERSACE REHABILITATION INC.
Entity type:Organization
Organization Name:VERSACE REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERSACE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:305-300-6011
Mailing Address - Street 1:1 GLEN ROYAL PKWY
Mailing Address - Street 2:1105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5287
Mailing Address - Country:US
Mailing Address - Phone:305-300-6011
Mailing Address - Fax:
Practice Address - Street 1:1 GLEN ROYAL PKWY
Practice Address - Street 2:1105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5287
Practice Address - Country:US
Practice Address - Phone:305-300-6011
Practice Address - Fax:305-468-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty