Healthcare Provider Details

I. General information

NPI: 1417227067
Provider Name (Legal Business Name): REHAB PLUS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620B CHERRY ST
CALLAWAY FL
32404-6734
US

IV. Provider business mailing address

5620B CHERRY ST
CALLAWAY FL
32404-6734
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-0007
  • Fax: 850-215-0006
Mailing address:
  • Phone: 850-215-0007
  • Fax: 850-215-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19861
License Number StateFL

VIII. Authorized Official

Name: RICHARD WOOTEN
Title or Position: PT/OWNER
Credential: PT
Phone: 850-215-0007