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General NPI Number Information
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NPI Number | 1104115112
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Entity Type | Organization
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Legal Business Name | ATLANTIC COAST MEDICAL REHAB
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 13171 ATLANTIC BLVD. SUITE #100
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City | JACKSONVILLE
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State | FL
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Zip | 32225
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Country | US
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Telephone | 904-888-6095
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Fax | 904-280-5238
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Provider Business Mailing Address
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Address Line | 13171 ATLANTIC BLVD. SUITE #100
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City | JACKSONVILLE
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State | FL
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Zip | 32225
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Country | US
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Telephone | 904-888-6095
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Fax | 904-280-5238
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TRACI ROSENSTEIN
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Credential |
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Telephone | 904-888-6095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME79945
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License Number State | FL
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