Provider Demographics
NPI:1154370831
Name:LA SCALA REHABILITATION INC
Entity type:Organization
Organization Name:LA SCALA REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:305-485-9847
Mailing Address - Street 1:8360 SW 40 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3354
Mailing Address - Country:US
Mailing Address - Phone:305-485-9847
Mailing Address - Fax:305-485-9850
Practice Address - Street 1:8360 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3354
Practice Address - Country:US
Practice Address - Phone:305-485-9847
Practice Address - Fax:305-485-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT108412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686793AMedicare Oscar/Certification