Provider Demographics
NPI:1699964734
Name:REHAB MEDICINE ASSOCIATES OF BREVARD PA
Entity type:Organization
Organization Name:REHAB MEDICINE ASSOCIATES OF BREVARD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYLL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-310-1642
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1317
Mailing Address - Country:US
Mailing Address - Phone:706-271-0010
Mailing Address - Fax:
Practice Address - Street 1:175 VILLA NUEVA AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2595
Practice Address - Country:US
Practice Address - Phone:321-952-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91705208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF33959Medicare UPIN
FLU4607AMedicare Oscar/Certification