Provider Demographics
NPI:1417243122
Name:TALLAHASSEE MEDICAL REHAB INC
Entity Type:Organization
Organization Name:TALLAHASSEE MEDICAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAKANTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-656-4800
Mailing Address - Street 1:5222 PIPER LANE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:321-363-4409
Mailing Address - Fax:321-363-4781
Practice Address - Street 1:5222 PIPER LANE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:321-363-4409
Practice Address - Fax:321-363-4781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALLAHASSEE MEDICAL REHAB INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-21
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty