Provider Demographics
NPI:1710592787
Name:INFINITE REHABILITATION AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:INFINITE REHABILITATION AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JESUS RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-560-2020
Mailing Address - Street 1:6349 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2707
Mailing Address - Country:US
Mailing Address - Phone:904-560-2020
Mailing Address - Fax:904-212-3272
Practice Address - Street 1:6349 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2707
Practice Address - Country:US
Practice Address - Phone:904-560-2020
Practice Address - Fax:904-212-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty