Provider Demographics
NPI:1588987069
Name:MED DIAGNOSTIC REHAB OF SOUTH FLORIDA
Entity type:Organization
Organization Name:MED DIAGNOSTIC REHAB OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-312-1120
Mailing Address - Street 1:8188 JOG RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2952
Mailing Address - Country:US
Mailing Address - Phone:561-649-5720
Mailing Address - Fax:561-649-5719
Practice Address - Street 1:8188 JOG RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2952
Practice Address - Country:US
Practice Address - Phone:561-649-5720
Practice Address - Fax:561-649-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686684OtherMEDICARE PROVIDER NUMBER