Healthcare Provider Details

I. General information

NPI: 1578565842
Provider Name (Legal Business Name): M & M REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 NW 9TH BLVD
GAINESVILLE FL
32605-4207
US

IV. Provider business mailing address

6608 NW 9TH BLVD
GAINESVILLE FL
32605-4207
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3399
  • Fax: 352-331-9927
Mailing address:
  • Phone: 352-331-3399
  • Fax: 352-331-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORT 62
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR 89
License Number StateFL

VIII. Authorized Official

Name: MR. VICTOR BUSTAMANTE
Title or Position: OWNER
Credential: LPO
Phone: 352-331-3399