MEDICARE: DOCTORS REHAB CLINIC 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	MM16615	FL

General Provider Information

NPI Number	:	1942410576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS REHAB CLINIC INC.

Provider Business Mailing Address
First Line	:	4602 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:	813-870-3990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANE D FERRELL
Credential	:
Telephone Number	:	813-870-3990

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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