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General NPI Number Information
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NPI Number | 1396020673
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Entity Type | Organization
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Legal Business Name | CLEVELAND REHAB CENTER CORP
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 3049 CLEVELAND AVE SUITE 130
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City | FORT MYERS
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State | FL
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Zip | 33901-7041
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Country | US
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Telephone | 239-288-5647
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Fax | 239-288-5654
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Provider Business Mailing Address
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Address Line | 3049 CLEVELAND AVE SUITE 130
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City | FORT MYERS
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State | FL
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Zip | 33901-7041
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Country | US
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Telephone | 239-288-5647
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Fax | 239-288-5654
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA C RIVAS
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Credential | DC
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Telephone | 239-288-5647
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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 | HCC 9451
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License Number State | FL
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