MEDICARE: SOLARIS REHAB, 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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1891263141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARIS REHAB, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2386
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34133-2386
Country	:	US
Telephone Number	:	239-514-2310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 SW 24TH AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7601
Country	:	US
Telephone Number	:	954-361-5502
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID R BOERKOEL
Credential	:
Telephone Number	:	239-514-2310

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	08/24/2022

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