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General NPI Number Information
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NPI Number | 1891703351
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Entity Type | Organization
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Legal Business Name | MEDICAL REHAB CLINIC OF BROWARD LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 1528 NE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1036
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Country | US
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Telephone | 954-467-8855
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Fax | 954-467-8857
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Provider Business Mailing Address
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Address Line | 1528 NE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1036
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Country | US
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Telephone | 954-467-8855
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Fax | 954-467-8857
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHARLES HARRY RICHARD
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Credential | D.O.
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Telephone | 954-467-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8590
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License Number State | FL
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