Healthcare Provider Details

I. General information

NPI: 1730931890
Provider Name (Legal Business Name): PREMIER REHABILITATION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 05/13/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 NW 16TH AVE UNIT 287
GAINESVILLE FL
32601-4012
US

IV. Provider business mailing address

419 SW 16TH AVE
OCALA FL
34471
US

V. Phone/Fax

Practice location:
  • Phone: 267-712-9894
  • Fax:
Mailing address:
  • Phone: 267-712-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAMMI PATEL
Title or Position: DIRECTOR
Credential: DO
Phone: 267-712-9894