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General NPI Number Information
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NPI Number | 1710932082
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Entity Type | Organization
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Legal Business Name | NEW LIFE REHAB, INC.
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 974 14TH LN
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City | VERO BEACH
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State | FL
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Zip | 32960-4734
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Country | US
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Telephone | 772-569-1453
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Fax | 772-569-3421
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Provider Business Mailing Address
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Address Line | 974 14TH LN
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City | VERO BEACH
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State | FL
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Zip | 32960-4734
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Country | US
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Telephone | 772-569-1453
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Fax | 772-569-3421
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JUDITH ANN HANSEN
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Credential |
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Telephone | 772-569-1453
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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 | PT8816
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License Number State | FL
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