Healthcare Provider Details

I. General information

NPI: 1457724171
Provider Name (Legal Business Name): FREEDOM REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17162 TOLEDO BLADE BLVD
PORT CHARLOTTE FL
33954-2626
US

IV. Provider business mailing address

3545 MASSINI AVE
NORTH PORT FL
34286-2412
US

V. Phone/Fax

Practice location:
  • Phone: 941-400-1505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA CARDONE VAN SALISBURY
Title or Position: CEO/OWNER
Credential: OTR/L
Phone: 941-539-2403