Healthcare Provider Details

I. General information

NPI: 1912081142
Provider Name (Legal Business Name): TLC REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6778 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-9348
US

IV. Provider business mailing address

PO BOX 741708
ATLANTA GA
30374-1708
US

V. Phone/Fax

Practice location:
  • Phone: 527-956-2253
  • Fax: 352-795-6065
Mailing address:
  • Phone: 352-382-7214
  • Fax: 352-382-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAPHNE SCOTT
Title or Position: PRESIDENT OF OUTPATIENT REHABILITAT
Credential: PT
Phone: 405-900-4729