Healthcare Provider Details

I. General information

NPI: 1093017386
Provider Name (Legal Business Name): SPECIALIZED REHAB SOLUTIONS,INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 NW SHIRLEY CT
PORT SAINT LUCIE FL
34986-3596
US

IV. Provider business mailing address

315 NW SHIRLEY CT
PORT SAINT LUCIE FL
34986-3596
US

V. Phone/Fax

Practice location:
  • Phone: 954-465-4467
  • Fax:
Mailing address:
  • Phone: 954-465-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KOURTNI DAMES
Title or Position: OWNER
Credential:
Phone: 954-465-4467