MEDICARE: RELIEF MD REHAB SPECIALISTS 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619431848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIEF MD REHAB SPECIALISTS INC

Provider Business Mailing Address
First Line	:	9542 SHEPARD PL
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 WINKLER AVE STE 118
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9301
Country	:	US
Telephone Number	:	561-929-6903
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIROJA N JAGMOHAN
Credential	:	MD
Telephone Number	:	561-929-6903

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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