MEDICARE: INJURY REHABILITATION CENTER, 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	261QP2000X	Physical Therapy Clinic/Center		FL

General Provider Information

NPI Number	:	1063797272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY REHABILITATION CENTER, INC

Provider Business Mailing Address
First Line	:	672 N SEMORAN BLVD
Second Line	:	SUITE 304
City	:	ORLANDO
State	:	FL
Zip	:	32807-3350
Country	:	US
Telephone Number	:	407-275-7767
Fax Number	:	407-275-7787

Provider Business Practice Location Address
First Line	:	672 N SEMORAN BLVD
Second Line	:	SUITE 304
City	:	ORLANDO
State	:	FL
Zip	:	32807-3350
Country	:	US
Telephone Number	:	407-275-7767
Fax Number	:	407-275-7787

Authorized Official
Title or Position	:	OWNER
Name	:	DAYLEANN VALLEJO
Credential	:	LMT
Telephone Number	:	407-275-7767

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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