Provider Demographics
NPI:1134306400
Name:ADVANCED REHAB CLINIC OF WINTER HAVEN
Entity Type:Organization
Organization Name:ADVANCED REHAB CLINIC OF WINTER HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH-CONSIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-649-2327
Mailing Address - Street 1:5340 RECKER HWY
Mailing Address - Street 2:BLDG. 2- SUITE A
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1256
Mailing Address - Country:US
Mailing Address - Phone:863-401-3430
Mailing Address - Fax:
Practice Address - Street 1:5340 RECKER HWY
Practice Address - Street 2:BLDG. 2- SUITE A
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1256
Practice Address - Country:US
Practice Address - Phone:954-649-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22997Medicare UPIN