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General NPI Number Information
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NPI Number | 1477574655
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Entity Type | Organization
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Legal Business Name | REHAB SOURCE P A
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 6825 DAVIS BLVD #157
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City | NAPLES
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State | FL
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Zip | 34104-5331
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Country | US
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Telephone | 239-643-7879
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Fax | 239-643-2951
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Provider Business Mailing Address
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Address Line | 6825 DAVIS BLVD APT 257
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City | NAPLES
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State | FL
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Zip | 34104-5326
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Country | US
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Telephone | 239-643-7879
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Fax | 239-643-2951
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDSEL PAGKANLUNGAN
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Credential |
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Telephone | 239-643-7879
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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 | PT0008895
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0007692
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License Number State | FL
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