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General NPI Number Information
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NPI Number | 1043669120
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Entity Type | Organization
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Legal Business Name | TREASURE COAST MOBILE REHAB
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1156 S OCEAN DR APT B
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City | FORT PIERCE
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State | FL
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Zip | 34949-3300
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Country | US
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Telephone | 216-392-1379
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Fax |
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Provider Business Mailing Address
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Address Line | 1156 S OCEAN DR APT B
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City | FORT PIERCE
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State | FL
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Zip | 34949-3300
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Country | US
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Telephone | 216-392-1379
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER HORNE
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Credential |
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Telephone | 216-392-1379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH10983
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License Number State | FL
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