Provider Demographics
NPI:1134500606
Name:ALLIED HEALTH & REHABILITATION
Entity Type:Organization
Organization Name:ALLIED HEALTH & REHABILITATION
Other - Org Name:MARIANNA HEALTH & REHAB
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-637-3416
Mailing Address - Street 1:177 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2809
Mailing Address - Country:US
Mailing Address - Phone:678-637-3416
Mailing Address - Fax:
Practice Address - Street 1:842 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-0403
Practice Address - Country:US
Practice Address - Phone:678-637-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10381111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4678377624OtherCERTIFIED MEDICAL EXAMINER (CME)