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General NPI Number Information
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NPI Number | 1962917153
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Entity Type | Organization
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Legal Business Name | REJUVEUNIQUE, INC
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Dates
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Enumeration Date | 12/10/2017
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Last Update Date | 12/10/2017
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Provider Practice Location Address
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Address Line | 4259 10TH AVE N STE B
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2323
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Country | US
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Telephone | 561-218-4951
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Fax | 561-218-4961
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Provider Business Mailing Address
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Address Line | 40 BARKLEY CIR STE 3
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City | FORT MYERS
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State | FL
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Zip | 33907-4518
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Country | US
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Telephone | 239-226-0910
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Fax | 239-226-0912
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KRISTEN J TOUHEY
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Credential |
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Telephone | 239-226-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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