Provider Demographics
NPI:1043341407
Name:FLORIDA REHABILITATION CENTER OF BROWARD COUNTY INC
Entity Type:Organization
Organization Name:FLORIDA REHABILITATION CENTER OF BROWARD COUNTY INC
Other - Org Name:FLORIDA REHABILITATION CTR OF BROWARD COUNTY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHWANI
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:954-473-6473
Mailing Address - Street 1:5504 NW 77TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2014
Mailing Address - Country:US
Mailing Address - Phone:954-473-6473
Mailing Address - Fax:954-345-3411
Practice Address - Street 1:3591 N ANDREWS AVE
Practice Address - Street 2:SUITE 5E
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5289
Practice Address - Country:US
Practice Address - Phone:954-473-6473
Practice Address - Fax:954-345-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106758Medicare Oscar/Certification