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General NPI Number Information
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NPI Number | 1023266046
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REHAB AND WELLNESS INC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1128 ROYAL PALM BEACH BLVD #243
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1693
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Country | US
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Telephone | 561-204-1694
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Fax | 561-204-1694
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Provider Business Mailing Address
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Address Line | 1128 ROYAL PALM BEACH BLVD #243
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1693
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Country | US
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Telephone |
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Fax | 561-204-1694
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DANIELLE RIVERA
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Credential | MSPT
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Telephone | 561-204-1694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT19335
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PT19335
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License Number State | FL
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