Provider Demographics
NPI:1558144782
Name:MEDICAL REHAB PRO LLC
Entity Type:Organization
Organization Name:MEDICAL REHAB PRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-751-4262
Mailing Address - Street 1:410 EVERNIA ST APT 511
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5436
Mailing Address - Country:US
Mailing Address - Phone:917-751-4262
Mailing Address - Fax:772-223-8938
Practice Address - Street 1:901 45TH STREET
Practice Address - Street 2:REHAB ADMIN
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:855-850-7032
Practice Address - Fax:772-223-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty