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General NPI Number Information
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NPI Number | 1063797272
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Entity Type | Organization
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Legal Business Name | INJURY REHABILITATION CENTER, INC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 672 N SEMORAN BLVD SUITE 304
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City | ORLANDO
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State | FL
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Zip | 32807-3350
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Country | US
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Telephone | 407-275-7767
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Fax | 407-275-7787
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Provider Business Mailing Address
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Address Line | 672 N SEMORAN BLVD SUITE 304
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City | ORLANDO
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State | FL
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Zip | 32807-3350
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Country | US
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Telephone | 407-275-7767
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Fax | 407-275-7787
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Authorized Official
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Title or Position | OWNER
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Name | DAYLEANN VALLEJO
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Credential | LMT
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Telephone | 407-275-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | FL
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