Provider Demographics
NPI:1619163482
Name:REHAB CLINICS OF AMERICA, LLC
Entity Type:Organization
Organization Name:REHAB CLINICS OF AMERICA, LLC
Other - Org Name:REHAB CLINIC OF DELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUNZIATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-275-1325
Mailing Address - Street 1:3651 PEACHTREE PKWY
Mailing Address - Street 2:SUITE E #312
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6034
Mailing Address - Country:US
Mailing Address - Phone:678-791-1916
Mailing Address - Fax:
Practice Address - Street 1:505 E NEW YORK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-6083
Practice Address - Country:US
Practice Address - Phone:386-734-3795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty