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General NPI Number Information
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NPI Number | 1033595475
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE OF KISSIMMEE INC
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Dates
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Enumeration Date | 08/08/2015
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Last Update Date | 08/08/2015
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Provider Practice Location Address
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Address Line | 2920 PLEASANT HILL RD
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City | KISSIMMEE
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State | FL
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Zip | 34746-3061
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Country | US
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Telephone | 407-282-3615
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Fax | 407-275-7221
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Provider Business Mailing Address
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Address Line | 2920 PLEASANT HILL RD
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City | KISSIMMEE
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State | FL
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Zip | 34746-3061
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Country | US
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Telephone | 407-282-3615
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Fax | 407-275-7221
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGEL M DE LOS REYES
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Credential | D.C.
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Telephone | 407-282-3615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | CH10807
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License Number State | FL
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