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General NPI Number Information
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NPI Number | 1093097180
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Entity Type | Organization
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Legal Business Name | I. C. PHYSICAL REHABILITATION SERVICES, INC.
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 814 SW 11TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33991-4400
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Country | US
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Telephone | 239-443-6264
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Fax | 239-573-5175
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Provider Business Mailing Address
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Address Line | 814 SW 11TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33991-4400
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Country | US
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Telephone | 239-443-6264
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Fax | 239-573-5175
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Authorized Official
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Title or Position | PRESIDENT
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Name | INES CASTRO
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Credential |
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Telephone | 239-443-6264
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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 | MA46555
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License Number State | FL
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