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General NPI Number Information
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NPI Number | 1649380411
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Entity Type | Organization
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Legal Business Name | INTEGRATED REHAB. PA
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 2180 SW 115TH TER
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City | DAVIE
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State | FL
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Zip | 33325-4854
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Country | US
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Telephone | 954-816-1029
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Fax | 954-577-3444
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Provider Business Mailing Address
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Address Line | 2180 SW 115TH TER
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City | DAVIE
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State | FL
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Zip | 33325-4854
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Country | US
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Telephone | 954-816-1029
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Fax | 954-577-3444
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Authorized Official
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Title or Position | OWNER
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Name | MARK NILES
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Credential | PT, MS, CSCS
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Telephone | 954-816-1029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4421
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License Number State | FL
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