=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780139006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFINITY REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2016
-----------------------------------------------------
Last Update Date | 11/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 GLENFIELD CT
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32712-2378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-235-8576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2763
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32704-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-235-8576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MR. DAMON T. GIVENS
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 386-453-1726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA9883
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT10897
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------