Provider Demographics
NPI:1417171406
Name:HOLISTIC REHABILITATION INC.
Entity Type:Organization
Organization Name:HOLISTIC REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-261-1066
Mailing Address - Street 1:2007 NE 40TH RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5122
Mailing Address - Country:US
Mailing Address - Phone:786-261-1066
Mailing Address - Fax:
Practice Address - Street 1:2007 NE 40TH RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5122
Practice Address - Country:US
Practice Address - Phone:786-261-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty