Healthcare Provider Details

I. General information

NPI: 1902412547
Provider Name (Legal Business Name): FLORIDA SENIOR REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SE ASTER LN
STUART FL
34994-5516
US

IV. Provider business mailing address

7730 CARONDELET AVE STE 400
CLAYTON MO
63105-3329
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 314-474-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVID CHURCH
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 314-474-8498