Provider Demographics
NPI:1790450450
Name:SOUFFRANTMD REHABMED CONSULTANTS PA
Entity Type:Organization
Organization Name:SOUFFRANTMD REHABMED CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:GUY-YOMA
Authorized Official - Last Name:SOUFFRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-465-9363
Mailing Address - Street 1:629 HUMMINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4772
Mailing Address - Country:US
Mailing Address - Phone:440-465-9363
Mailing Address - Fax:
Practice Address - Street 1:2795 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3705
Practice Address - Country:US
Practice Address - Phone:321-622-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty