Provider Demographics
NPI:1306082276
Name:JOJO REHAB THERAPY. LLC.
Entity type:Organization
Organization Name:JOJO REHAB THERAPY. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMELITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARDELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-682-0053
Mailing Address - Street 1:3515 PALM HARBOR BVLD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1416
Mailing Address - Country:US
Mailing Address - Phone:727-682-0056
Mailing Address - Fax:727-935-4844
Practice Address - Street 1:10929 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3747
Practice Address - Country:US
Practice Address - Phone:727-682-0056
Practice Address - Fax:727-935-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
FLHCC10350261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDJ663AMedicare PIN