Provider Demographics
NPI:1922406826
Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHAB LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-496-5144
Mailing Address - Street 1:13550 JOG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3808
Mailing Address - Country:US
Mailing Address - Phone:561-496-5144
Mailing Address - Fax:561-496-5201
Practice Address - Street 1:13550 JOG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3808
Practice Address - Country:US
Practice Address - Phone:561-496-5144
Practice Address - Fax:561-496-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL14000182172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty