Healthcare Provider Details

I. General information

NPI: 1982306007
Provider Name (Legal Business Name): HANDS ON NEUROREHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 ACAPULCO DR
RIVERVIEW FL
33578-3701
US

IV. Provider business mailing address

10810 BOYETTE RD PO BOX 512 P.O BOX 512
RIVERVIEW FL
33569
US

V. Phone/Fax

Practice location:
  • Phone: 813-625-7461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MARIE HENRY
Title or Position: MANAGER
Credential: OTD
Phone: 813-625-7461