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NPI Code Detail

MEDICARE: OPTIMUM REHABILITATION SPECIALISTS

MEDICARE: OPTIMUM REHABILITATION SPECIALISTS
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
1174400000XSpecialistPT0009763FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2686674OTHERFLMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RE1OTHERFLBCBS
3RE1OTHERFLBCBS FLORIDA
4RB6OTHERFLBCBS FLORIDA

General Provider Information

NPI Number : 1619936663
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIMUM REHABILITATION SPECIALISTS
Provider Business Mailing Address
First Line : PO BOX 3576
Second Line :
City : APOLLO BEACH
State : FL
Zip : 33572-1005
Country : US
Telephone Number : 330-285-0592
Fax Number : 888-803-9101
Provider Business Practice Location Address
First Line : 2718 LEE BLVD #C
Second Line :
City : LEHIGH ACRES
State : FL
Zip : 33971-1537
Country : US
Telephone Number : 239-303-9100
Fax Number : 239-303-9101
Authorized Official
Title or Position : MD
Name : DR. BRENDAN MALIK
Credential : MD
Telephone Number : 330-285-0592
Provider Enumeration Date : 03/20/2006
Last Update Date : 11/08/2020

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Directions to “OPTIMUM REHABILITATION SPECIALISTS ” Practice Location

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