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General NPI Number Information
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NPI Number | 1588074058
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Entity Type | Organization
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Legal Business Name | MARCIA NATHAN
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 1084 LEE RD SUITE 7
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City | ORLANDO
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State | FL
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Zip | 32810-5821
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Country | US
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Telephone | 407-953-8714
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Fax | 407-293-8891
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Provider Business Mailing Address
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Address Line | 1084 LEE RD SUITE 7
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City | ORLANDO
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State | FL
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Zip | 32810-5821
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Country | US
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Telephone | 407-953-8714
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Fax | 407-293-8891
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARCIA A NATHAN
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Credential | LMT
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Telephone | 407-953-8714
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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 | MA72562
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License Number State | FL
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