Healthcare Provider Details

I. General information

NPI: 1073059705
Provider Name (Legal Business Name): PHYSICAL REHAB AND MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N WICKHAM RD #116
MELBOURNE FL
32940-2028
US

IV. Provider business mailing address

1861 S PATRICK DR #137
INDIAN HARBOUR BEACH FL
32937-4377
US

V. Phone/Fax

Practice location:
  • Phone: 321-757-6899
  • Fax: 321-757-6859
Mailing address:
  • Phone: 321-757-6899
  • Fax: 321-757-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NICOLE M ESPINOZA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 321-757-6899