MEDICARE: PREVENTATIVE MEDICAL & REHAB, INC

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	:	1598711608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTATIVE MEDICAL & REHAB, INC

Provider Business Mailing Address
First Line	:	4900 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4251
Country	:	US
Telephone Number	:	727-992-1696
Fax Number	:	727-846-9906

Provider Business Practice Location Address
First Line	:	4900 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4251
Country	:	US
Telephone Number	:	727-992-1696
Fax Number	:	727-846-9906

Authorized Official
Title or Position	:	DIRECTOR/VICE PRESIDENT
Name	:	MRS. CONNIE JO AZIROVIC
Credential	:
Telephone Number	:	727-992-1696

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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