MEDICARE: SAND LAKE REHAB & WELLNESS 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	261Q00000X	Clinic/Center	HCC9064	FL

General Provider Information

NPI Number	:	1447559570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND LAKE REHAB & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	1650 SAND LAKE RD
Second Line	:	STE. 255
City	:	ORLANDO
State	:	FL
Zip	:	32809-7681
Country	:	US
Telephone Number	:	407-704-5518
Fax Number	:	407-704-5526

Provider Business Practice Location Address
First Line	:	1650 SAND LAKE RD
Second Line	:	STE. 255
City	:	ORLANDO
State	:	FL
Zip	:	32809-7681
Country	:	US
Telephone Number	:	407-704-5518
Fax Number	:	407-704-5526

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERADIO SOSA
Credential	:
Telephone Number	:	407-704-5518

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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