Provider Demographics
NPI:1023256310
Name:FLORIDA WELLNESS & REHABILITATION CENTER OF HOMESTEAD, INC
Entity type:Organization
Organization Name:FLORIDA WELLNESS & REHABILITATION CENTER OF HOMESTEAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-246-0056
Mailing Address - Street 1:207 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6018
Mailing Address - Country:US
Mailing Address - Phone:305-246-0056
Mailing Address - Fax:305-246-0093
Practice Address - Street 1:207 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6018
Practice Address - Country:US
Practice Address - Phone:305-246-0056
Practice Address - Fax:305-246-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty