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General NPI Number Information
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NPI Number | 1518391523
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Entity Type | Organization
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Legal Business Name | SMC REHAB SERVICES, LLC
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 3512 S ATLANTIC AVE
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-7639
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Country | US
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Telephone | 386-767-9544
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Fax | 386-767-9914
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Provider Business Mailing Address
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Address Line | 3512 S ATLANTIC AVE
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-7639
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Country | US
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Telephone | 386-767-9544
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Fax | 386-767-9914
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Authorized Official
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Title or Position | OWNER
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Name | GERALD R WOODARD
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Credential | DO
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Telephone | 386-767-9544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | OS4717
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License Number State | FL
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