Healthcare Provider Details

I. General information

NPI: 1255753885
Provider Name (Legal Business Name): PHYSIO REHAB CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NE 26TH ST SUITE 101
WILTON MANORS FL
33305-1416
US

IV. Provider business mailing address

1881 NE 26TH ST SUITE 101
WILTON MANORS FL
33305-1416
US

V. Phone/Fax

Practice location:
  • Phone: 954-821-0271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK LALONDE
Title or Position: PT
Credential:
Phone: 954-821-0271