Provider Demographics
NPI:1114367901
Name:FIRST MEDICAL AND REHAB OF BRADENTON, LLC
Entity Type:Organization
Organization Name:FIRST MEDICAL AND REHAB OF BRADENTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-567-5669
Mailing Address - Street 1:3220 1ST STREET WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4055
Mailing Address - Country:US
Mailing Address - Phone:941-567-5669
Mailing Address - Fax:941-896-9706
Practice Address - Street 1:3220 1ST STREET WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4055
Practice Address - Country:US
Practice Address - Phone:941-567-5669
Practice Address - Fax:941-896-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty