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General NPI Number Information
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NPI Number | 1538727516
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Entity Type | Organization
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Legal Business Name | 360 REHAB SERVICES INC.
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 12251 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1901
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Country | US
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Telephone | 954-648-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 12251 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1901
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Country | US
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Telephone | 954-648-5565
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAINIELLE GORDON-CORNWALL
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Credential | DPT
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Telephone | 954-648-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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