Provider Demographics
NPI:1124772553
Name:PURE REHABILITATION SOUTH, LLC
Entity type:Organization
Organization Name:PURE REHABILITATION SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAFFNER-SZYNSKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-0123
Mailing Address - Street 1:18650 GULF BLVD UNIT 414
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2080
Mailing Address - Country:US
Mailing Address - Phone:712-542-0123
Mailing Address - Fax:712-850-1349
Practice Address - Street 1:18650 GULF BLVD UNIT 414
Practice Address - Street 2:
Practice Address - City:INDIAN SHORES
Practice Address - State:FL
Practice Address - Zip Code:33785-2080
Practice Address - Country:US
Practice Address - Phone:712-542-0123
Practice Address - Fax:712-850-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty