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General NPI Number Information
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NPI Number | 1649582693
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Entity Type | Organization
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Legal Business Name | MUSCULOSKELETAL REHAB, INC.
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 245 S HIGHLAND ST SUITE 6
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City | MOUNT DORA
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State | FL
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Zip | 32757-5781
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Country | US
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Telephone | 352-383-0004
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Fax | 352-383-0004
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Provider Business Mailing Address
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Address Line | 530 E 1ST AVE
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City | MOUNT DORA
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State | FL
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Zip | 32757-5609
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Country | US
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Telephone | 352-383-0004
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Fax | 352-383-0004
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | SHAMAYA CHAH
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Credential | LMT
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Telephone | 352-383-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA4338
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License Number State | FL
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