MEDICARE: PHYSICIANS OF REHAB SERVICES 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
1	208100000X	Physical Medicine & Rehabilitation Physician	OS12890	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS12890	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1407228539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS OF REHAB SERVICES LLC

Provider Business Mailing Address
First Line	:	3105 GRAND AVE APT 401
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-6107
Country	:	US
Telephone Number	:	561-926-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 GRAND AVE APT 401
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-6107
Country	:	US
Telephone Number	:	608-216-4474
Fax Number	:

Authorized Official
Title or Position	:	OSTEOPATHIS PHYSICIAN
Name	:	DR. SANDRA SANDHU
Credential	:	D.O.
Telephone Number	:	561-926-5482

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	01/23/2024

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