Healthcare Provider Details

I. General information

NPI: 1518736297
Provider Name (Legal Business Name): VITALITY REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 FOUR LAKES CIR SW
VERO BEACH FL
32968-4802
US

IV. Provider business mailing address

1647 SW 22ND TER
OKEECHOBEE FL
34974-5672
US

V. Phone/Fax

Practice location:
  • Phone: 772-913-1517
  • Fax:
Mailing address:
  • Phone: 863-634-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE C WIDEBERG
Title or Position: OWNER
Credential:
Phone: 772-913-1517