Provider Demographics
NPI:1598711608
Name:PREVENTATIVE MEDICAL & REHAB, INC
Entity Type:Organization
Organization Name:PREVENTATIVE MEDICAL & REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:AZIROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-992-1696
Mailing Address - Street 1:4900 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4251
Mailing Address - Country:US
Mailing Address - Phone:727-992-1696
Mailing Address - Fax:727-846-9906
Practice Address - Street 1:4900 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4251
Practice Address - Country:US
Practice Address - Phone:727-992-1696
Practice Address - Fax:727-846-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686837Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY