Healthcare Provider Details

I. General information

NPI: 1801137674
Provider Name (Legal Business Name): ASPIRE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 37TH ST STE 111
VERO BEACH FL
32960-6518
US

IV. Provider business mailing address

326 15TH AVE
VERO BEACH FL
32962-2749
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-6962
  • Fax: 772-365-0499
Mailing address:
  • Phone: 772-257-6962
  • Fax: 772-365-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12097
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberSA12097
License Number StateFL

VIII. Authorized Official

Name: MRS. JACQUELINE MELISSA SUMNER DAVIS
Title or Position: OWNER
Credential: MA, CCC-SLP
Phone: 772-257-6962