Basic Information
| Provider Information | |||||||||
| NPI: | 1588755086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VITAL REHAB INTERVENTION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 236 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337800236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275423580 | ||||||||
| FaxNumber: | 7275486131 | ||||||||
| Practice Location | |||||||||
| Address1: | 10707 66TH ST N STE 14 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337822336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275478600 | ||||||||
| FaxNumber: | 7275486131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 04/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRESBITERO | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | TERESA | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7278042103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
| NPICertificationDate: | 04/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT6356 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | PT0010934 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.