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General NPI Number Information
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NPI Number | 1700902160
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Entity Type | Organization
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Legal Business Name | ADVANCE REHAB SERVICES P A
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 7471 W OAKLAND PARK BLVD SUITE 103
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City | LAUDERHILL
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State | FL
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Zip | 33319-4921
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Country | US
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Telephone | 954-748-7555
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Fax | 954-748-4910
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Provider Business Mailing Address
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Address Line | 7471 W OAKLAND PARK BLVD SUITE 103
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City | LAUDERHILL
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State | FL
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Zip | 33319-4921
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Country | US
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Telephone | 954-748-7555
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Fax | 954-748-4910
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SANJIV S SHAH
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Credential | R.P.T.
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Telephone | 954-748-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | P.T. 0003694
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License Number State | FL
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