Provider Demographics
NPI:1548368939
Name:DIMAB REHAB INC
Entity type:Organization
Organization Name:DIMAB REHAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-4099
Mailing Address - Street 1:10 NW 42ND AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5473
Mailing Address - Country:US
Mailing Address - Phone:305-477-4099
Mailing Address - Fax:305-477-4199
Practice Address - Street 1:10 NW 42ND AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5473
Practice Address - Country:US
Practice Address - Phone:305-477-4099
Practice Address - Fax:305-477-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686670Medicare ID - Type Unspecified