MEDICARE: UNIVERSAL REHAB MED GROUP, 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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261QP2000X	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1700028610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL REHAB MED GROUP, INC.

Provider Business Mailing Address
First Line	:	2925 10TH AVE N STE 201C
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3046
Country	:	US
Telephone Number	:	561-966-9957
Fax Number	:	561-966-9958

Provider Business Practice Location Address
First Line	:	2925 10TH AVE N STE 201C
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3046
Country	:	US
Telephone Number	:	561-966-9957
Fax Number	:	561-966-9958

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAZARO RODRIGUEZ
Credential	:	D.C.
Telephone Number	:	561-966-9957

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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