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General NPI Number Information
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NPI Number | 1518736297
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Entity Type | Organization
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Legal Business Name | VITALITY REHAB SERVICES LLC
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 4745 FOUR LAKES CIR SW
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City | VERO BEACH
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State | FL
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Zip | 32968-4802
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Country | US
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Telephone | 772-913-1517
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Fax |
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Provider Business Mailing Address
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Address Line | 1647 SW 22ND TER
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City | OKEECHOBEE
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State | FL
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Zip | 34974-5672
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Country | US
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Telephone | 863-634-3023
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANETTE C WIDEBERG
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Credential |
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Telephone | 772-913-1517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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