Provider Demographics
NPI:1922385160
Name:PARADISE MEDICAL REHAB LLC
Entity Type:Organization
Organization Name:PARADISE MEDICAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:239-234-5817
Mailing Address - Street 1:3960 RADIO RD STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3741
Mailing Address - Country:US
Mailing Address - Phone:239-234-5817
Mailing Address - Fax:239-234-5851
Practice Address - Street 1:3960 RADIO RD STE 108
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3741
Practice Address - Country:US
Practice Address - Phone:239-234-5817
Practice Address - Fax:239-234-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy