Provider Demographics
NPI:1508999772
Name:PINES TOTAL REHABILITATION HEALTH CENTER CORP
Entity Type:Organization
Organization Name:PINES TOTAL REHABILITATION HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:954-961-9335
Mailing Address - Street 1:2241 N UNIVERSITY DR
Mailing Address - Street 2:STE B
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3611
Mailing Address - Country:US
Mailing Address - Phone:954-961-9335
Mailing Address - Fax:954-961-9336
Practice Address - Street 1:2241 N UNIVERSITY DR
Practice Address - Street 2:STE B
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-961-9335
Practice Address - Fax:954-961-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy