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General NPI Number Information
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NPI Number | 1336291921
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Entity Type | Organization
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Legal Business Name | SANDALWOOD REHABILITATION & ERGONOMICS INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 7651 SW HIGHWAY 200 STE 206
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City | OCALA
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State | FL
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Zip | 34476-7727
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Country | US
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Telephone | 352-425-3882
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 773694
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City | OCALA
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State | FL
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Zip | 34477-3694
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Country | US
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Telephone | 352-425-3882
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAMAL MODY
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Credential | RPT
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Telephone | 352-425-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT21367
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License Number State | FL
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