Provider Demographics
NPI: | 1356641443 |
---|---|
Name: | J & J UNITED REHABILITATION, LLC |
Entity Type: | Organization |
Organization Name: | J & J UNITED REHABILITATION, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-OWNER, ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JESSICA |
Authorized Official - Middle Name: | LEE |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 352-871-6783 |
Mailing Address - Street 1: | 5516 NW 27TH TER |
Mailing Address - Street 2: | |
Mailing Address - City: | GAINESVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32653-2040 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5516 NW 27TH TER |
Practice Address - Street 2: | |
Practice Address - City: | GAINESVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32653-2040 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-871-6783 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-10-24 |
Last Update Date: | 2010-10-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OT9490 | 225400000X, 225CA2400X, 225CA2500X, 225X00000X, 225XE0001X, 225XG0600X, 225XP0019X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Multi-Specialty | |
No | 225CA2400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Practitioner | Group - Multi-Specialty |
No | 225CA2500X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Supplier | Group - Multi-Specialty |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | Group - Multi-Specialty |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | Group - Multi-Specialty |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |