Healthcare Provider Details

I. General information

NPI: 1598601825
Provider Name (Legal Business Name): CRESTCARE REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 LONG IRON DR APT 807
ROCKLEDGE FL
32955-6602
US

IV. Provider business mailing address

1841 LONG IRON DR APT 807
ROCKLEDGE FL
32955-6602
US

V. Phone/Fax

Practice location:
  • Phone: 321-382-1240
  • Fax:
Mailing address:
  • Phone: 321-382-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL EZECHUKWU NDUKWU
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 228-365-8476