Healthcare Provider Details

I. General information

NPI: 1730549411
Provider Name (Legal Business Name): PRO REHAB GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S HOSPITAL DR SUITE 100
PLANTATION FL
33317-2813
US

IV. Provider business mailing address

3190 S STATE ROAD 7 SUITE 12B
MIRAMAR FL
33023-5280
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-0511
  • Fax: 954-961-0519
Mailing address:
  • Phone: 954-961-0511
  • Fax: 954-961-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYDIA POSADA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 954-961-0511