Provider Demographics
NPI:1255660841
Name:JDR REHAB INC
Entity Type:Organization
Organization Name:JDR REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RASPILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-871-9221
Mailing Address - Street 1:6555 NW 36TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6903
Mailing Address - Country:US
Mailing Address - Phone:305-871-9221
Mailing Address - Fax:
Practice Address - Street 1:6555 NW 36TH ST STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6903
Practice Address - Country:US
Practice Address - Phone:305-871-9221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty