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General NPI Number Information
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NPI Number | 1447559570
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Entity Type | Organization
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Legal Business Name | SAND LAKE REHAB & WELLNESS CENTER INC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 1650 SAND LAKE RD STE. 255
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City | ORLANDO
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State | FL
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Zip | 32809-7681
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Country | US
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Telephone | 407-704-5518
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Fax | 407-704-5526
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Provider Business Mailing Address
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Address Line | 1650 SAND LAKE RD STE. 255
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City | ORLANDO
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State | FL
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Zip | 32809-7681
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Country | US
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Telephone | 407-704-5518
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Fax | 407-704-5526
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERADIO SOSA
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Credential |
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Telephone | 407-704-5518
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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 | HCC9064
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License Number State | FL
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