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General NPI Number Information
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NPI Number | 1265751077
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Entity Type | Organization
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Legal Business Name | LG REHAB CENTER, INC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 28331 S TAMIAMI TRL
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3215
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Country | US
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Telephone | 239-498-0117
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Fax | 239-498-0142
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Provider Business Mailing Address
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Address Line | 28331 S TAMIAMI TRL
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3215
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Country | US
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Telephone | 239-498-0117
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Fax | 239-498-0142
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WILLIAM J BROGNA
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Credential | CHIROPRACTOR
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Telephone | 239-498-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC8099
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License Number State | FL
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