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NPI Code Detail

MEDICARE: SMC REHAB SERVICES, LLC

MEDICARE: SMC 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
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianOS4717FL

General Provider Information

NPI Number : 1518391523
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMC REHAB SERVICES, LLC
Provider Business Mailing Address
First Line : 3512 S ATLANTIC AVE
Second Line :
City : DAYTONA BEACH SHORES
State : FL
Zip : 32118-7639
Country : US
Telephone Number : 386-767-9544
Fax Number : 386-767-9914
Provider Business Practice Location Address
First Line : 3512 S ATLANTIC AVE
Second Line :
City : DAYTONA BEACH SHORES
State : FL
Zip : 32118-7639
Country : US
Telephone Number : 386-767-9544
Fax Number : 386-767-9914
Authorized Official
Title or Position : OWNER
Name : GERALD R WOODARD
Credential : DO
Telephone Number : 386-767-9544
Provider Enumeration Date : 08/27/2013
Last Update Date : 08/27/2013

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Practice Location Address:
3512 S ATLANTIC AVE
DAYTONA BEACH SHORES, FL
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Practice Fax: 386-756-0501
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1346690484 — DR. LAUREN A GIRARD DO
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DAYTONA BEACH SHORES, FL
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1518433804 — TARA JAMES FNP
Practice Location Address:
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Practice Fax: 386-767-9914

Directions to “SMC REHAB SERVICES, LLC ” Practice Location

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