Provider Demographics
NPI:1508801911
Name:TRINITY REHABILITATION CLINIC, INC.
Entity Type:Organization
Organization Name:TRINITY REHABILITATION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SOLADOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-969-1726
Mailing Address - Street 1:2629 CREIGHTON RD
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7340
Mailing Address - Country:US
Mailing Address - Phone:850-969-1726
Mailing Address - Fax:850-969-7926
Practice Address - Street 1:2629 CREIGHTON RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7340
Practice Address - Country:US
Practice Address - Phone:850-969-1726
Practice Address - Fax:850-969-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3377Medicare ID - Type UnspecifiedGROUP NUMBER