Organization
PREMIER ATHLETIC REHAB CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEJANDRO G GONZALEZ DPT (PHYSICAL THERAPIST)
(305) 282-7252
Entity
Organization
Contact information
Practice address
3121 PONCE DE LEON BLVD, CORAL GABLES, FL 33134-6816
(305) 396-9002
(305) 390-3003
Mailing address
PO BOX 450844, MIAMI, FL 33245-0844
(305) 396-9002
(305) 390-3003
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT25977
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2801168
CIGNA
FL
01
—
Y07QR
BCBS
FL
Enumeration date
04/18/2012
Last updated
11/19/2013
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