Provider Demographics
NPI: | 1457750259 |
---|---|
Name: | I REHAB NOW LLC |
Entity Type: | Organization |
Organization Name: | I REHAB NOW LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/MGR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | TUCCIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 813-562-9715 |
Mailing Address - Street 1: | 16313 MUIRFIELD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ODESSA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33556 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 31608 US 19 |
Practice Address - Street 2: | |
Practice Address - City: | PALM HARBOR |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34684 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-317-5486 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-18 |
Last Update Date: | 2014-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PT20245 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 1710975339 | Other | NPI |