Provider Demographics
NPI:1093017386
Name:SPECIALIZED REHAB SOLUTIONS,INC,
Entity Type:Organization
Organization Name:SPECIALIZED REHAB SOLUTIONS,INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOURTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-465-4467
Mailing Address - Street 1:315 NW SHIRLEY CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3596
Mailing Address - Country:US
Mailing Address - Phone:954-465-4467
Mailing Address - Fax:
Practice Address - Street 1:315 NW SHIRLEY CT
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3596
Practice Address - Country:US
Practice Address - Phone:954-465-4467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720399556OtherNPI,INDIVIDUAL
FL890876100Medicaid