Provider Demographics
NPI:1295963106
Name:REHAC, RAFAEL (LMT)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:REHAC
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 SW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3909
Mailing Address - Country:US
Mailing Address - Phone:239-223-9532
Mailing Address - Fax:
Practice Address - Street 1:415 CAPE CORAL PKWY W
Practice Address - Street 2:#1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6563
Practice Address - Country:US
Practice Address - Phone:239-540-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist