Provider Demographics
NPI:1336455435
Name:CORA
Entity type:Organization
Organization Name:CORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:OTHON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-479-7593
Mailing Address - Street 1:19501 E COUNTRY CLUB DR
Mailing Address - Street 2:#9304
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2551
Mailing Address - Country:US
Mailing Address - Phone:954-790-2186
Mailing Address - Fax:
Practice Address - Street 1:1893 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-5035
Practice Address - Country:US
Practice Address - Phone:305-682-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25769261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy