Provider Demographics
NPI:1356764302
Name:COMPREHENSIVE HOLISTIC REHAB CLINIC
Entity type:Organization
Organization Name:COMPREHENSIVE HOLISTIC REHAB CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-628-2478
Mailing Address - Street 1:2040 COLLIER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8124
Mailing Address - Country:US
Mailing Address - Phone:954-628-2478
Mailing Address - Fax:
Practice Address - Street 1:2040 COLLIER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8124
Practice Address - Country:US
Practice Address - Phone:954-628-2478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM31700261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center