Provider Demographics
NPI:1992144141
Name:FLORIDA FALL PREVENTION AND REHABILITATION LLC
Entity type:Organization
Organization Name:FLORIDA FALL PREVENTION AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRIMER
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D,, PT
Authorized Official - Phone:321-508-3250
Mailing Address - Street 1:850 LOGGERHEAD ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3845
Mailing Address - Country:US
Mailing Address - Phone:321-508-3250
Mailing Address - Fax:
Practice Address - Street 1:850 LOGGERHEAD ISLAND DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3845
Practice Address - Country:US
Practice Address - Phone:321-508-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL13000085254253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care