Healthcare Provider Details

I. General information

NPI: 1376872481
Provider Name (Legal Business Name): BROWARD MEDICAL & REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S. FEDERAL HIGHWAY
HOLLYWOOD FL
33020
US

IV. Provider business mailing address

750 S. FEDERAL HIGHWAY
HOLLYWOOD FL
33020
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-7333
  • Fax: 954-925-7339
Mailing address:
  • Phone: 954-925-7333
  • Fax: 954-925-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7442
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS0007659
License Number StateFL

VIII. Authorized Official

Name: DR. BRUCE MARK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 954-925-7333