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General NPI Number Information
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NPI Number | 1245533959
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Entity Type | Organization
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Legal Business Name | SHINE REHAB INC
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 2301 TAMIAMI TRL SUITE C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-3907
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Country | US
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Telephone | 941-625-1252
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Fax | 941-625-0616
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Provider Business Mailing Address
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Address Line | 2301 TAMIAMI TRAIL SUITE C
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-625-1252
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Fax | 941-625-0616
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. ROWENA CABADING MERCADO
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Credential | PT
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Telephone | 941-625-1252
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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 | PT10614
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License Number State | FL
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