Provider Demographics
NPI:1073059705
Name:PHYSICAL REHAB AND MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSICAL REHAB AND MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-757-6899
Mailing Address - Street 1:1861 S PATRICK DR
Mailing Address - Street 2:#137
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4377
Mailing Address - Country:US
Mailing Address - Phone:321-757-6899
Mailing Address - Fax:321-757-6859
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:#116
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-757-6899
Practice Address - Fax:321-757-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1383ZMedicare UPIN