MEDICARE: NOVACARE REHABILITATION

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	225100000X	Physical Therapist	18749	FL

General Provider Information

NPI Number	:	1477504496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVACARE REHABILITATION

Provider Business Mailing Address
First Line	:	1944 NW 169TH AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2036
Country	:	US
Telephone Number	:	305-613-8958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 NE 48TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4517
Country	:	US
Telephone Number	:	954-772-1799
Fax Number	:

Authorized Official
Title or Position	:	CENTER MANAGER
Name	:	MRS. ILEANA BRINIS
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	954-772-1799

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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