Organization Name: | TREASURE COAST MOBILE REHAB |
NPI Number: | 1043669120 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTOPHER HORNE (OWNER) |
Mailing Address: | 1156 S Ocean Dr Apt B Fort Pierce |
State: | FL US |
Postal Code: | 349493300 |
Phone Number: | 2163921379 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2016 |
NPI Last Update Date: | 06/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | CH10983 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |