Healthcare Provider Details

I. General information

NPI: 1518436989
Provider Name (Legal Business Name): NEW LIFE REHAB MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 9TH ST N STE E
NAPLES FL
34102-8100
US

IV. Provider business mailing address

689 9TH ST N STE E
NAPLES FL
34102-8100
US

V. Phone/Fax

Practice location:
  • Phone: 239-302-5081
  • Fax: 239-330-7068
Mailing address:
  • Phone: 239-302-5081
  • Fax: 239-330-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. YISEL ZEQUEIRA
Title or Position: ADMINISTRATION
Credential:
Phone: 239-302-5081