Provider Demographics
NPI:1124160817
Name:HOLLYWOOD INJURY REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:HOLLYWOOD INJURY REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-963-1899
Mailing Address - Street 1:2544 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3205
Mailing Address - Country:US
Mailing Address - Phone:954-963-1899
Mailing Address - Fax:
Practice Address - Street 1:2544 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3205
Practice Address - Country:US
Practice Address - Phone:954-963-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5346204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty