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General NPI Number Information
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NPI Number | 1609103993
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL REHAB INC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 123 US 27 S
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City | LAKE PLACID
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State | FL
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Zip | 33852-7918
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Country | US
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Telephone | 863-441-1226
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Fax | 863-465-7790
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Provider Business Mailing Address
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Address Line | 123 US 27 S
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City | LAKE PLACID
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State | FL
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Zip | 33852-7918
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Country | US
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Telephone | 863-441-1226
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Fax | 863-465-7790
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. NOSTER R VILLAMOR
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Credential | RPT
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Telephone | 863-441-1226
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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 | PT7249
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License Number State | FL
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