Basic Information
| Provider Information | |||||||||
| NPI: | 1720503279 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FL REHAB SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FLORIDA REHABILITATION SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 N OLD DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | LADY LAKE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321594347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527516627 | ||||||||
| FaxNumber: | 3527516628 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 N OLD DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | LADY LAKE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321594347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527516627 | ||||||||
| FaxNumber: | 3527516628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DINAL | ||||||||
| AuthorizedOfficialFirstName: | ARTEMIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3527156627 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.