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General NPI Number Information
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NPI Number | 1033989116
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Entity Type | Organization
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Legal Business Name | AGEWELL REHAB SERVICES PLLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1111 STRATFORD AVE APT 319
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City | STRATFORD
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State | CT
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Zip | 06615-6379
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Country | US
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Telephone | 786-266-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 STRATFORD AVE APT 319
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City | STRATFORD
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State | CT
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Zip | 06615-6379
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Country | US
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Telephone | 786-266-4504
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CLAUDIA GARCIA
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Credential | MSOT/L
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Telephone | 786-266-4504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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