Provider Demographics
NPI:1184655656
Name:MED DIAGNOSTIC REHAB OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:MED DIAGNOSTIC REHAB OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA,MHSA, BBA
Authorized Official - Phone:561-312-1120
Mailing Address - Street 1:2462 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6812
Mailing Address - Country:US
Mailing Address - Phone:954-942-0927
Mailing Address - Fax:954-942-1110
Practice Address - Street 1:2462 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6812
Practice Address - Country:US
Practice Address - Phone:954-942-0927
Practice Address - Fax:954-942-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686684273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686684Medicare ID - Type UnspecifiedOUTPATIENT THERAPY