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General NPI Number Information
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NPI Number | 1194393413
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Entity Type | Organization
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Legal Business Name | VITALOGY REHAB SERVICES INC.
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 7550 60TH WAY N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3216
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Country | US
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Telephone | 727-541-4239
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Fax | 727-546-9351
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Provider Business Mailing Address
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Address Line | 7550 60TH WAY N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3216
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Country | US
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Telephone | 727-541-4239
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Fax | 727-546-9351
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHAWN ALLEN FOURMAN
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Credential | LNHA
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Telephone | 727-541-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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