=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609733880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORVIA CARDIAC REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9300 CONROY WINDERMERE RD UNIT 161
-----------------------------------------------------
City | WINDERMERE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34786-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-224-7899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9300 CONROY WINDERMERE RD UNIT 161
-----------------------------------------------------
City | WINDERMERE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34786-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-224-7899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PHYSICIAN
-----------------------------------------------------
Name | DR. ADETOLUWA IJIDAKINRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-900-8098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------