Provider Demographics
NPI:1558315663
Name:MEDICAL & SPORTS REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:MEDICAL & SPORTS REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YURKOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-261-0291
Mailing Address - Street 1:689 TAMIAMI TRL N
Mailing Address - Street 2:STE E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8100
Mailing Address - Country:US
Mailing Address - Phone:239-261-0291
Mailing Address - Fax:239-261-0678
Practice Address - Street 1:661 GOODLETTE RD N
Practice Address - Street 2:STE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5609
Practice Address - Country:US
Practice Address - Phone:239-261-4592
Practice Address - Fax:239-261-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT0001402OtherPT LICENSE NUMBER
FLPT0004535OtherPT LICENSE NUMBER
FLR32OtherBCBS PROVIDER NUMBER
FLOT6930OtherOT LICENSE NUMBER
FLOT9990OtherOT LICENSE NUMBER
FLPT21393OtherPT LICENSE NUMBER
FLOT8618OtherOT LICENSE NUMBER
FLPT0001402OtherPT LICENSE NUMBER
FL106531Medicare ID - Type UnspecifiedMEDICARE NUMBER