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General NPI Number Information
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NPI Number | 1063583516
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Entity Type | Organization
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Legal Business Name | INNOVATIVE REHAB AND WELLNESS INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 575 SARINA TER SW
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City | VERO BEACH
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State | FL
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Zip | 32968-4042
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Country | US
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Telephone | 772-696-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 575 SARINA TER SW
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City | VERO BEACH
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State | FL
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Zip | 32968-4042
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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 | VP
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Name | TAVI MCLEOD
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Credential |
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Telephone | 772-696-4883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT9096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0016300
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License Number State | FL
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