Provider Demographics
NPI:1700028610
Name:UNIVERSAL REHAB MED GROUP, INC.
Entity Type:Organization
Organization Name:UNIVERSAL REHAB MED GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-966-9957
Mailing Address - Street 1:2925 10TH AVE N STE 201C
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3046
Mailing Address - Country:US
Mailing Address - Phone:561-966-9957
Mailing Address - Fax:561-966-9958
Practice Address - Street 1:2925 10TH AVE N STE 201C
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3046
Practice Address - Country:US
Practice Address - Phone:561-966-9957
Practice Address - Fax:561-966-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261QP2000XOtherAHCA