MEDICARE: INNOVATIVE MEDICAL REHAB CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician	ME32051	FL

General Provider Information

NPI Number	:	1043657109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE MEDICAL REHAB CENTER

Provider Business Mailing Address
First Line	:	3960 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5240
Country	:	US
Telephone Number	:	954-533-5060
Fax Number	:	754-200-5416

Provider Business Practice Location Address
First Line	:	3960 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5240
Country	:	US
Telephone Number	:	954-533-5060
Fax Number	:	754-200-5416

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LOUIS ROBINSON
Credential	:
Telephone Number	:	954-533-5060

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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