Healthcare Provider Details

I. General information

NPI: 1801160189
Provider Name (Legal Business Name): LIGHT REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 N UNIVERSITY DR SUITE 201
TAMARAC FL
33321-2908
US

IV. Provider business mailing address

11302 SW 55TH ST
COOPER CITY FL
33330-4503
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-3031
  • Fax: 954-963-7169
Mailing address:
  • Phone: 954-257-7919
  • Fax: 954-963-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT3616
License Number StateFL

VIII. Authorized Official

Name: MR. VINOD THAKAR
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: R.P.T.
Phone: 954-257-7919