Provider Demographics
NPI:1932460342
Name:FAMILY PRACTICE AND REHAB, INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-467-8855
Mailing Address - Street 1:723 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4882
Mailing Address - Country:US
Mailing Address - Phone:407-250-6739
Mailing Address - Fax:407-250-6741
Practice Address - Street 1:723 W OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4882
Practice Address - Country:US
Practice Address - Phone:407-250-6739
Practice Address - Fax:407-250-6741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL REHAB CLINIC OF BROWARD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-01
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty