Provider Demographics
NPI:1962759357
Name:VITAL HEALTH MEDICAL REHABILITATION INC
Entity type:Organization
Organization Name:VITAL HEALTH MEDICAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-835-0973
Mailing Address - Street 1:422 7TH ST
Mailing Address - Street 2:STE A8-288
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3922
Mailing Address - Country:US
Mailing Address - Phone:561-835-0973
Mailing Address - Fax:561-686-6298
Practice Address - Street 1:422 7TH ST
Practice Address - Street 2:STE A8-288
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3922
Practice Address - Country:US
Practice Address - Phone:561-835-0973
Practice Address - Fax:561-686-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty