Provider Demographics
NPI:1649422494
Name:MEDICAL REHABILITATION SPECIALIST III INC
Entity Type:Organization
Organization Name:MEDICAL REHABILITATION SPECIALIST III INC
Other - Org Name:INJURY CARE CLINIC OF TALLAHASSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-402-0200
Mailing Address - Street 1:PO BOX 12578
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-2578
Mailing Address - Country:US
Mailing Address - Phone:850-402-0200
Mailing Address - Fax:850-402-0564
Practice Address - Street 1:2648 CENTENNIAL PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0572
Practice Address - Country:US
Practice Address - Phone:850-402-0200
Practice Address - Fax:850-402-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty