Provider Demographics
NPI:1578920252
Name:SOLARIS REHAB, LLC
Entity Type:Organization
Organization Name:SOLARIS REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOERKOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, OTR/L
Authorized Official - Phone:239-300-2207
Mailing Address - Street 1:PO BOX 2386
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34133-2386
Mailing Address - Country:US
Mailing Address - Phone:239-314-5410
Mailing Address - Fax:
Practice Address - Street 1:5859 HERITAGE PARK WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8557
Practice Address - Country:US
Practice Address - Phone:561-266-4652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686902OtherMEDICARE PTAN