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General NPI Number Information
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NPI Number | 1699947465
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Entity Type | Organization
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Legal Business Name | REHABILITATION CONSULTANTS PA
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 13685 DOCTORS WAY STE 190
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City | FORT MYERS
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State | FL
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Zip | 33912-4336
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Country | US
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Telephone | 239-768-5454
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Fax | 239-768-5432
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Provider Business Mailing Address
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Address Line | PO BOX 60013
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City | FORT MYERS
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State | FL
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Zip | 33906-6013
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Country | US
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Telephone | 239-768-5454
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Fax | 239-768-5432
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBRA K ROGGOW
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Credential | D.O.
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Telephone | 239-768-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | OS6278
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License Number State | FL
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