Provider Demographics
NPI:1104458413
Name:LIFE MEDICAL REHABILITATION CORP
Entity type:Organization
Organization Name:LIFE MEDICAL REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-715-7432
Mailing Address - Street 1:1890 SW 57TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2164
Mailing Address - Country:US
Mailing Address - Phone:786-431-5898
Mailing Address - Fax:786-485-3189
Practice Address - Street 1:1890 SW 57TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2164
Practice Address - Country:US
Practice Address - Phone:786-431-5898
Practice Address - Fax:786-485-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy