Provider Demographics
NPI:1083912372
Name:PALM BEACH REHABILITATION SERVICES,INC
Entity Type:Organization
Organization Name:PALM BEACH REHABILITATION SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANYELEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-541-5405
Mailing Address - Street 1:1490 S MILITARY TRL
Mailing Address - Street 2:STE 6
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9190
Mailing Address - Country:US
Mailing Address - Phone:561-345-3192
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL
Practice Address - Street 2:STE 6
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9190
Practice Address - Country:US
Practice Address - Phone:561-345-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAHCA HCC 10316261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service