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General NPI Number Information
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NPI Number | 1679511364
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Entity Type | Organization
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Legal Business Name | SPECTRUM REHABILITATION AND WELLNESS INC.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 341 N MAITLAND AVE STE 290
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City | MAITLAND
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State | FL
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Zip | 32751-4761
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Country | US
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Telephone | 321-295-7170
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Fax | 321-697-7002
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Provider Business Mailing Address
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Address Line | 341 N MAITLAND AVE STE 290
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City | MAITLAND
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State | FL
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Zip | 32751-4761
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Country | US
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Telephone | 321-295-7170
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Fax | 321-697-7002
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Authorized Official
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Title or Position | OWNER
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Name | MANUEL VICENTE MEDINA
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Credential |
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Telephone | 407-587-9580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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