Provider Demographics
NPI:1578565842
Name:M & M REHAB INC
Entity Type:Organization
Organization Name:M & M REHAB INC
Other - Org Name:MID-FLORIDA PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:352-331-3399
Mailing Address - Street 1:6608 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4207
Mailing Address - Country:US
Mailing Address - Phone:352-331-3399
Mailing Address - Fax:352-331-9927
Practice Address - Street 1:6608 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4207
Practice Address - Country:US
Practice Address - Phone:352-331-3399
Practice Address - Fax:352-331-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 62335E00000X
FLPOR 89335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021922300Medicaid
FL022619000Medicare ID - Type Unspecified
FL1267440002Medicare ID - Type Unspecified