Healthcare Provider Details

I. General information

NPI: 1407324775
Provider Name (Legal Business Name): OCALA REHABILITATION PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OAKBRIDGE PKWY
LAKELAND FL
33803-5945
US

IV. Provider business mailing address

1317 EDGEWATER DR # 2945
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 863-279-1600
  • Fax:
Mailing address:
  • Phone: 407-538-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN E CLEMONS
Title or Position: OWNER
Credential: MD
Phone: 407-538-5921