=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851713960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AARP PHYSICAL MEDICINE AND REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2014
-----------------------------------------------------
Last Update Date | 01/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8686A E COUNTY ROAD 466
-----------------------------------------------------
City | LADY LAKE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32162-3670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-250-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1960 BRIDGEWATER DR
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-6907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-250-2252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | JAMES M RAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 352-250-2252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------