Healthcare Provider Details

I. General information

NPI: 1982720371
Provider Name (Legal Business Name): REHAB RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 E BLOOMINGDALE AVE
BRANDON FL
33511-8155
US

IV. Provider business mailing address

600 NORTH BLVD W
LEESBURG FL
34748-5063
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-6636
  • Fax: 352-787-4522
Mailing address:
  • Phone: 352-725-6636
  • Fax: 352-787-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DONNA J RODRIGUEZ
Title or Position: CEO
Credential: RPT
Phone: 352-728-6636