Healthcare Provider Details

I. General information

NPI: 1750955985
Provider Name (Legal Business Name): KANDO REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N ASHLEY DR UNIT 3209
TAMPA FL
33602-4387
US

IV. Provider business mailing address

777 N ASHLEY DR UNIT 3209
TAMPA FL
33602-4387
US

V. Phone/Fax

Practice location:
  • Phone: 813-541-1872
  • Fax: 813-441-8121
Mailing address:
  • Phone: 813-541-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MERRYN K MATHEW
Title or Position: OWNER
Credential: DPT
Phone: 813-541-1872