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General NPI Number Information
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NPI Number | 1053983361
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 10050 SW INNOVATION WAY STE 104
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2117
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Country | US
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Telephone | 877-328-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 CENTERVIEW DR STE 107
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City | RALEIGH
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State | NC
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Zip | 27606-3563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KAREN VAUGHN
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Credential |
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Telephone | 404-450-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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