Provider Demographics
NPI:1649582693
Name:MUSCULOSKELETAL REHAB, INC.
Entity type:Organization
Organization Name:MUSCULOSKELETAL REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-383-0004
Mailing Address - Street 1:530 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5609
Mailing Address - Country:US
Mailing Address - Phone:352-383-0004
Mailing Address - Fax:352-383-0004
Practice Address - Street 1:245 S HIGHLAND ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5781
Practice Address - Country:US
Practice Address - Phone:352-383-0004
Practice Address - Fax:352-383-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA4338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty