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NPI Code Detail

MEDICARE: REDCON1 RECOVERY LLC

MEDICARE: REDCON1 RECOVERY LLC
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
1163WI0500XInfusion Therapy Registered Nurse
2225700000XMassage Therapist
3363A00000XPhysician Assistant
42081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number : 1396319612
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDCON1 RECOVERY LLC
Provider Business Mailing Address
First Line : 990 S ROGERS CIR STE 7
Second Line :
City : BOCA RATON
State : FL
Zip : 33487-2836
Country : US
Telephone Number : 407-572-0313
Fax Number :
Provider Business Practice Location Address
First Line : 990 S ROGERS CIR STE 7
Second Line :
City : BOCA RATON
State : FL
Zip : 33487-2836
Country : US
Telephone Number : 407-572-0313
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : ERIC OTERO
Credential : DPT
Telephone Number : 407-922-7622
Provider Enumeration Date : 05/20/2021
Last Update Date : 05/20/2021

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Directions to “REDCON1 RECOVERY LLC ” Practice Location

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