Healthcare Provider Details

I. General information

NPI: 1699866988
Provider Name (Legal Business Name): REHAB 1OF CHARLOTTE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 TAMIAMI TRL SUITE A
PORT CHARLOTTE FL
33952-9209
US

IV. Provider business mailing address

4166 TAMIAMI TRL SUITE A
PORT CHARLOTTE FL
33952-9209
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-1110
  • Fax: 941-766-1190
Mailing address:
  • Phone: 941-766-1110
  • Fax: 941-766-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE HIZON
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-766-1110