Healthcare Provider Details

I. General information

NPI: 1902857949
Provider Name (Legal Business Name): FLORIDA REHAB CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S 10TH ST
HAINES CITY FL
33844-5619
US

IV. Provider business mailing address

306 S 10TH ST
HAINES CITY FL
33844-5619
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-9060
  • Fax: 863-422-0035
Mailing address:
  • Phone: 863-422-9060
  • Fax: 863-422-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1290005586
License Number StateFL

VIII. Authorized Official

Name: MR. DWIGHT ALEXANDER ANGELITO
Title or Position: OFFICE MANAGER
Credential:
Phone: 863-422-9060