MEDICARE: ADVANCED REHABILITATION MEDICAL SERVICES

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	ME0066000	FL

General Provider Information

NPI Number	:	1174520910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED REHABILITATION MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 510816
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33951-0816
Country	:	US
Telephone Number	:	941-764-7117
Fax Number	:	941-764-1049

Provider Business Practice Location Address
First Line	:	4265 LAURA ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2836
Country	:	US
Telephone Number	:	941-764-7117
Fax Number	:	941-764-1049

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH ANTHONY WILLIAMS
Credential	:	M.D.
Telephone Number	:	941-764-7117

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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