Healthcare Provider Details

I. General information

NPI: 1356641443
Provider Name (Legal Business Name): J & J UNITED REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2010
Last Update Date: 10/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5516 NW 27TH TER
GAINESVILLE FL
32653-2040
US

IV. Provider business mailing address

5516 NW 27TH TER
GAINESVILLE FL
32653-2040
US

V. Phone/Fax

Practice location:
  • Phone: 352-871-6783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberOT9490
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License NumberOT9490
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License NumberOT9490
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9490
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT9490
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT9490
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT9490
License Number StateFL

VIII. Authorized Official

Name: MRS. JESSICA LEE JOHNSON
Title or Position: CO-OWNER, ADMINISTRATOR
Credential:
Phone: 352-871-6783