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General NPI Number Information
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NPI Number | 1063833671
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Entity Type | Organization
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Legal Business Name | VITALY REHAB INCORPORATED
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 12450 TIMIAMI TRAIL SUITE-E
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City | NORTH PORT
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State | FL
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Zip | 34287
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Country | US
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Telephone | 941-257-4763
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Fax |
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Provider Business Mailing Address
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Address Line | 21499 PEACHLAND BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954
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Country | US
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Telephone | 941-249-1913
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. VITALY BELEVITCH
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Credential | MPT
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Telephone | 941-249-1913
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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 | PT26357
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License Number State | PA
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