MEDICARE: PIRANI HOLDING COMPANY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1215678289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIRANI HOLDING COMPANY, PLLC

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1602
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6298
Country	:	US
Telephone Number	:	904-945-7556
Fax Number	:	904-379-0113

Provider Business Practice Location Address
First Line	:	1855 WELLS RD STE 3B
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6766
Country	:	US
Telephone Number	:	904-945-7556
Fax Number	:	904-379-0113

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DIVYA MAJMUDAR PIRANI
Credential	:	PT, DPT, PCS
Telephone Number	:	904-945-7556

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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