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General NPI Number Information
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NPI Number | 1124772553
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Entity Type | Organization
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Legal Business Name | PURE REHABILITATION SOUTH, LLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 18650 GULF BLVD UNIT 414
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City | INDIAN SHORES
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State | FL
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Zip | 33785-2080
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Country | US
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Telephone | 712-542-0123
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Fax | 712-850-1349
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Provider Business Mailing Address
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Address Line | 18650 GULF BLVD UNIT 414
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City | INDIAN SHORES
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State | FL
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Zip | 33785-2080
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Country | US
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Telephone | 712-542-0123
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Fax | 712-850-1349
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Authorized Official
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Title or Position | ADMIN
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Name | MISTY ANN HAFFNER-SZYNSKIE
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Credential |
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Telephone | 712-542-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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