Healthcare Provider Details

I. General information

NPI: 1124497417
Provider Name (Legal Business Name): FUNCTIONAL REHAB SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 01/04/2022
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 NW BEACON SQUARE BLVD STE 101
BOCA RATON FL
33487-1345
US

IV. Provider business mailing address

7815 NW BEACON SQUARE BLVD STE 101
BOCA RATON FL
33487-1345
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-0136
  • Fax: 561-995-0138
Mailing address:
  • Phone: 561-995-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9743
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11831
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11942
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15792
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SEYED HESSAM KHATAMI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 561-995-0136