Provider Demographics
NPI:1679881890
Name:PALMETTO GENERAL MEDICAL REHAB INC
Entity type:Organization
Organization Name:PALMETTO GENERAL MEDICAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-824-8888
Mailing Address - Street 1:2604 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5703
Mailing Address - Country:US
Mailing Address - Phone:305-824-8888
Mailing Address - Fax:305-824-8854
Practice Address - Street 1:2604 W 84 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-824-8888
Practice Address - Fax:305-824-8854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO GENERAL MEDICAL REHAB INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service