MEDICARE: BROAD RIVER REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1679283998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD RIVER REHABILITATION

Provider Business Mailing Address
First Line	:	1 POND ST
Second Line	:
City	:	ARDEN
State	:	NC
Zip	:	28704-8500
Country	:	US
Telephone Number	:	828-774-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-440-0175
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ANNETTE HASSEN
Credential	:
Telephone Number	:	828-774-5222

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “BROAD RIVER REHABILITATION ” Practice Location

Language	Start Address	Practice Location

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