Healthcare Provider Details

I. General information

NPI: 1295897536
Provider Name (Legal Business Name): PALM REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STIRLING RD STE 303
HOLLYWOOD FL
33024-8066
US

IV. Provider business mailing address

9900 STIRLING RD STE 303
HOLLYWOOD FL
33024-8066
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-8872
  • Fax: 954-432-9913
Mailing address:
  • Phone: 954-432-8872
  • Fax: 954-432-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberHCC4519
License Number StateFL

VIII. Authorized Official

Name: MR. KENNETH BERG
Title or Position: PRESIDENT
Credential:
Phone: 954-748-7474