Healthcare Provider Details

I. General information

NPI: 1184655656
Provider Name (Legal Business Name): MED DIAGNOSTIC REHAB OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2462 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6812
US

IV. Provider business mailing address

2462 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6812
US

V. Phone/Fax

Practice location:
  • Phone: 954-942-0927
  • Fax: 954-942-1110
Mailing address:
  • Phone: 954-942-0927
  • Fax: 954-942-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number686684
License Number StateFL

VIII. Authorized Official

Name: MR. RICH HOFFMAN
Title or Position: PRESIDENT
Credential: PTA,MHSA, BBA
Phone: 561-312-1120