Healthcare Provider Details

I. General information

NPI: 1063583516
Provider Name (Legal Business Name): INNOVATIVE REHAB AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SARINA TER SW
VERO BEACH FL
32968-4042
US

IV. Provider business mailing address

575 SARINA TER SW
VERO BEACH FL
32968-4042
US

V. Phone/Fax

Practice location:
  • Phone: 772-696-4883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0016300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9096
License Number StateFL

VIII. Authorized Official

Name: TAVI MCLEOD
Title or Position: VP
Credential:
Phone: 772-696-4883