1568952240 NPI number — SOUTH FLORIDA PHYSICAL MEDICINE AND REHABILITATION CENTER LLC

Table of content: (NPI 1568952240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568952240 NPI number — SOUTH FLORIDA PHYSICAL MEDICINE AND REHABILITATION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA PHYSICAL MEDICINE AND REHABILITATION CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1568952240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 223152
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33422-3152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-270-9146
Provider Business Mailing Address Fax Number:
561-992-8872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S MAIN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE GLADE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33430-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-270-9146
Provider Business Practice Location Address Fax Number:
561-992-8872
Provider Enumeration Date:
05/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
THOMSPON
Authorized Official First Name:
LAVITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
561-996-7585

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  ME114223 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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