Provider Demographics
NPI:1053728287
Name:PHYSICAL MEDICINE AND REHABILITATION OF S.E. FLORIDA INC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION OF S.E. FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-644-2234
Mailing Address - Street 1:2096 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4455
Mailing Address - Country:US
Mailing Address - Phone:954-431-8022
Mailing Address - Fax:954-431-8078
Practice Address - Street 1:2096 SW 163RD AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4455
Practice Address - Country:US
Practice Address - Phone:954-431-8022
Practice Address - Fax:954-431-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97569208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty