Provider Demographics
NPI:1336291921
Name:SANDALWOOD REHABILITATION & ERGONOMICS INC
Entity Type:Organization
Organization Name:SANDALWOOD REHABILITATION & ERGONOMICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:352-425-3882
Mailing Address - Street 1:PO BOX 773694
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-3694
Mailing Address - Country:US
Mailing Address - Phone:352-425-3882
Mailing Address - Fax:
Practice Address - Street 1:7651 SW HIGHWAY 200 STE 206
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-7727
Practice Address - Country:US
Practice Address - Phone:352-425-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9417Medicare ID - Type Unspecified