Provider Demographics
NPI:1134335557
Name:COCONUT CREEK REHABILITATION INC
Entity type:Organization
Organization Name:COCONUT CREEK REHABILITATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-972-1200
Mailing Address - Street 1:4915 COCONUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3909
Mailing Address - Country:US
Mailing Address - Phone:954-972-1200
Mailing Address - Fax:954-972-6212
Practice Address - Street 1:4915 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3909
Practice Address - Country:US
Practice Address - Phone:954-972-1200
Practice Address - Fax:954-972-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686506Medicare PIN