Provider Demographics
NPI:1871549881
Name:SOUTH FLORIDA PAIN & REHABILITATION OF WEST BROWARD
Entity type:Organization
Organization Name:SOUTH FLORIDA PAIN & REHABILITATION OF WEST BROWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-466-5665
Mailing Address - Street 1:1814 NE MIAMI GARDENS DR
Mailing Address - Street 2:#201
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5043
Mailing Address - Country:US
Mailing Address - Phone:305-466-5665
Mailing Address - Fax:305-466-8580
Practice Address - Street 1:7501 W OAKLAND PARK BLVD
Practice Address - Street 2:#101
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4982
Practice Address - Country:US
Practice Address - Phone:954-746-2662
Practice Address - Fax:954-746-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID