=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447577085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIONI REHABILITATION SERVICE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2010
-----------------------------------------------------
Last Update Date | 04/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6414 WEBSTER AVE
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-324-9459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6414 WEBSTER AVE
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33405-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-324-9459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DIOSNILEY ACANDA SR.
-----------------------------------------------------
Credential | MASSAGE THERAPIST
-----------------------------------------------------
Telephone | 561-324-9459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | MA 57603
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------