Basic Information
| Provider Information | |||||||||
| NPI: | 1821040460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA REHABILITATION SPECIALIST, LLC | ||||||||
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| Address1: | 134 N OLD DIXIE HWY | ||||||||
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| 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: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | DINAL | ||||||||
| AuthorizedOfficialFirstName: | ARTEMIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3527516627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.