MEDICARE: M & M REHAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003022351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & M REHAB INC

Provider Business Mailing Address
First Line	:	6608 NW 9TH BLVD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-4207
Country	:	US
Telephone Number	:	352-331-3399
Fax Number	:	352-331-9927

Provider Business Practice Location Address
First Line	:	221 SW STONEGATE TER STE 107
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3463
Country	:	US
Telephone Number	:	386-755-5774
Fax Number	:	352-331-9927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VICTOR BUSTAMANTE
Credential	:	CPO
Telephone Number	:	352-331-3399

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/07/2020

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Directions to “M & M REHAB INC ” Practice Location

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