MEDICARE: HOLLYWOOD 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	HCC5346	FL

General Provider Information

NPI Number	:	1124160817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD INJURY REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-963-1899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-963-1899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT C LEWIN
Credential	:	D.C.
Telephone Number	:	954-963-1899

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/31/2009

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