Provider Demographics
NPI:1588749329
Name:PROFESSIONAL MEDICAL REHABILITATION INC.
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL REHABILITATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKOLNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-924-0049
Mailing Address - Street 1:4548 DEER TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5608
Mailing Address - Country:US
Mailing Address - Phone:941-924-0049
Mailing Address - Fax:941-924-0049
Practice Address - Street 1:4548 DEER TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5608
Practice Address - Country:US
Practice Address - Phone:941-924-0049
Practice Address - Fax:941-924-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43831283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4251Medicare PIN