Provider Demographics
NPI:1982012134
Name:COMPLETE MEDICAL SPINAL REHAB INC
Entity Type:Organization
Organization Name:COMPLETE MEDICAL SPINAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-455-4181
Mailing Address - Street 1:12975 COLLIER BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-4004
Mailing Address - Country:US
Mailing Address - Phone:239-455-4181
Mailing Address - Fax:239-455-3896
Practice Address - Street 1:12975 COLLIER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-4004
Practice Address - Country:US
Practice Address - Phone:239-455-4181
Practice Address - Fax:239-455-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty