Healthcare Provider Details

I. General information

NPI: 1639440431
Provider Name (Legal Business Name): HOMETOWN REHAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 E LOUISE LN SUITE 110
HERNANDO FL
34442-4396
US

IV. Provider business mailing address

PO BOX 787
LECANTO FL
34460-0787
US

V. Phone/Fax

Practice location:
  • Phone: 352-422-7194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA DY-TALAROC
Title or Position: OWNER
Credential: PT
Phone: 352-422-7194