Provider Demographics
NPI:1154588044
Name:LEESBURG REHABILITATION SPECIALISTS
Entity type:Organization
Organization Name:LEESBURG REHABILITATION SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENCESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:CANAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-751-6627
Mailing Address - Street 1:33006 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7509
Mailing Address - Country:US
Mailing Address - Phone:352-751-6627
Mailing Address - Fax:
Practice Address - Street 1:33006 PROFESSIONAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7509
Practice Address - Country:US
Practice Address - Phone:352-751-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty