Provider Demographics
NPI:1992818363
Name:BRAUN GOODLANDER REHABILITATION & FITNESS SERVICES
Entity type:Organization
Organization Name:BRAUN GOODLANDER REHABILITATION & FITNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:941-906-9484
Mailing Address - Street 1:3277 FRUITVILLE RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6410
Mailing Address - Country:US
Mailing Address - Phone:941-906-9484
Mailing Address - Fax:941-906-1099
Practice Address - Street 1:3277 FRUITVILLE ROAD
Practice Address - Street 2:SUITE #3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-1308
Practice Address - Country:US
Practice Address - Phone:941-906-9484
Practice Address - Fax:941-906-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRG1OtherBCBSF
FL68-6672Medicare ID - Type UnspecifiedMEDICARE - ORF