Healthcare Provider Details

I. General information

NPI: 1053764001
Provider Name (Legal Business Name): INJURY CENTRAL REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

11564 MIZZON DR UNIT 926
WINDERMERE FL
34786-5554
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-2190
  • Fax:
Mailing address:
  • Phone: 386-898-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH10745
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberCH10745
License Number StateFL

VIII. Authorized Official

Name: DR. HECTOR RAMOS MENDEZ
Title or Position: DOCTOR
Credential: DC
Phone: 386-898-6783