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General NPI Number Information
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NPI Number | 1548651656
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Entity Type | Organization
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Legal Business Name | ACTIVE BODY REHAB AND CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 6388 SILVER STAR RD E1
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City | ORLANDO
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State | FL
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Zip | 32818-3235
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Country | US
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Telephone | 321-332-2689
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 771116
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City | ORLANDO
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State | FL
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Zip | 32877-1116
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Country | US
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Telephone | 321-332-2689
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MINEAUX SAUNDERS
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Credential | D.C.
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Telephone | 321-332-2689
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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 | CH10788
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License Number State | FL
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