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General NPI Number Information
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NPI Number | 1255660841
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Entity Type | Organization
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Legal Business Name | JDR REHAB INC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 6555 NW 36TH ST STE 108
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6903
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Country | US
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Telephone | 305-871-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 NW 36TH ST STE 108
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6903
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Country | US
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Telephone | 305-871-9221
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS MAGGIE RASPILLER
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Credential |
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Telephone | 305-871-9221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 42361
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License Number State | FL
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