Provider Demographics
NPI:1679511364
Name:SPECTRUM REHABILITATION AND WELLNESS INC.
Entity Type:Organization
Organization Name:SPECTRUM REHABILITATION AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:VICENTE
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-587-9580
Mailing Address - Street 1:341 N MAITLAND AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4761
Mailing Address - Country:US
Mailing Address - Phone:321-295-7170
Mailing Address - Fax:321-697-7002
Practice Address - Street 1:341 N MAITLAND AVE STE 290
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4761
Practice Address - Country:US
Practice Address - Phone:321-295-7170
Practice Address - Fax:321-697-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-3238Medicare ID - Type Unspecified