Healthcare Provider Details

I. General information

NPI: 1699947465
Provider Name (Legal Business Name): REHABILITATION CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY STE 190
FORT MYERS FL
33912-4336
US

IV. Provider business mailing address

PO BOX 60013
FORT MYERS FL
33906-6013
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-5454
  • Fax: 239-768-5432
Mailing address:
  • Phone: 239-768-5454
  • Fax: 239-768-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS6278
License Number StateFL

VIII. Authorized Official

Name: DR. DEBRA K ROGGOW
Title or Position: PRESIDENT
Credential: D.O.
Phone: 239-768-5454