=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306146501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNOVATIVE REHAB SOLUTIONS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2010
-----------------------------------------------------
Last Update Date | 10/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2825 N STATE ROAD 7 SUITE 203
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-5737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-975-2007
-----------------------------------------------------
Fax | 954-979-2958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10465 NW 65TH DR
-----------------------------------------------------
City | PARKLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33076-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-600-4602
-----------------------------------------------------
Fax | 954-600-4602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARCY GOLDINER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-600-4602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | ORT 56
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------