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General NPI Number Information
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NPI Number | 1366776312
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Entity Type | Organization
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Legal Business Name | ACCESS REHAB & REJUVENATION, LLC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 208 S HARRISON ST
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-4061
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Country | US
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Telephone | 352-364-0045
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Fax | 352-364-0047
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Provider Business Mailing Address
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Address Line | 208 S HARRISON ST
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-4061
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Country | US
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Telephone | 352-364-0045
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Fax | 352-364-0047
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIJAYASEKHARA R KALAKATA
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Credential | MD
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Telephone | 352-364-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME101929
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License Number State | FL
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