Provider Demographics
NPI:1972760494
Name:ORTHOPEDIC REHAB OF HALLANDALE INC
Entity Type:Organization
Organization Name:ORTHOPEDIC REHAB OF HALLANDALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC N MD
Authorized Official - Phone:954-458-9890
Mailing Address - Street 1:PO BOX 801108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33280-1108
Mailing Address - Country:US
Mailing Address - Phone:954-458-9890
Mailing Address - Fax:954-458-9996
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:UNIT 202
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2400
Practice Address - Country:US
Practice Address - Phone:954-458-9890
Practice Address - Fax:954-458-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4840111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050908600Medicaid
FLCH4840OtherFLORIDA BOARD DC MEDICINE LICENSE
FL1073672846OtherNPI
FLCH4840OtherFLORIDA BOARD DC MEDICINE LICENSE
FL1073672846OtherNPI