Provider Demographics
NPI:1447285093
Name:INDEPENDENCE REHABILITATION GROUP, INC.
Entity type:Organization
Organization Name:INDEPENDENCE REHABILITATION GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:305-799-1084
Mailing Address - Street 1:14440 SW 93RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7909
Mailing Address - Country:US
Mailing Address - Phone:305-799-1084
Mailing Address - Fax:305-969-2021
Practice Address - Street 1:14440 SW 93RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7909
Practice Address - Country:US
Practice Address - Phone:305-799-1084
Practice Address - Fax:305-969-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0011568261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6853Medicare ID - Type UnspecifiedPROVIDER #