MEDICARE: DM REHAB CORE LLC

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982216321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DM REHAB CORE LLC

Provider Business Mailing Address
First Line	:	3985 NW COLONIAL GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 SW STONEGATE TER
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3456
Country	:	US
Telephone Number	:	386-401-4309
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARQUS FISHER
Credential	:
Telephone Number	:	386-401-4309

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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Directions to “DM REHAB CORE LLC ” Practice Location

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