Provider Demographics
NPI:1063833671
Name:VITALY REHAB INCORPORATED
Entity Type:Organization
Organization Name:VITALY REHAB INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VITALY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELEVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:941-249-1913
Mailing Address - Street 1:21499 PEACHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954
Mailing Address - Country:US
Mailing Address - Phone:941-249-1913
Mailing Address - Fax:
Practice Address - Street 1:12450 TIMIAMI TRAIL
Practice Address - Street 2:SUITE-E
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287
Practice Address - Country:US
Practice Address - Phone:941-257-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT26357261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy