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General NPI Number Information
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NPI Number | 1720161193
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REHAB ORTHO LABS INC
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Dates
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Enumeration Date | 10/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8401 W MCNAB RD
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City | TAMARAC
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State | FL
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Zip | 33321-3207
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Country | US
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Telephone | 954-721-7301
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Fax | 954-721-7453
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Provider Business Mailing Address
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Address Line | 8401 W MCNAB RD
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City | TAMARAC
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State | FL
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Zip | 33321-3207
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Country | US
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Telephone | 954-721-7301
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Fax | 954-721-7453
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. JEFFREY WAYNE HYMAN
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Credential | CERTIFIED ORTHOTIST
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Telephone | 954-721-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | FL
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