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Organization
PHYSICAL MEDICINE AND REHABILITATION, PA
Active
Organization
PHYSICAL MEDICINE AND REHABILITATION, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT COOLIDGE (AGENT/REPRESENTATIVE)
(386) 774-5211
Entity
Organization
Contact information
Practice address
1133 SAXON BLVD, ORANGE CITY, FL 32763-8470
(386) 775-7080
(386) 775-8070
Mailing address
PO BOX 741240, ORANGE CITY, FL 32774-1240
(386) 774-5211
(386) 774-5251
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME95874
FL
Other
Enumeration date
08/30/2007
Last updated
03/26/2009
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