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Organization
PREMIER REHAB INC
Active
Organization
PREMIER REHAB INC
Active
Other names
Fyzical Therapy and Balance Center
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA ANNETTE DIVINCENZO OTR/L, CHT (ADMINISTRATOR/ CEO)
(386) 736-3108
Entity
Organization
Contact information
Practice address
911 N SPRING GARDEN AVE, DELAND, FL 32720
(386) 736-3108
(386) 736-3643
Mailing address
911 N SPRING GARDEN AVE, DELAND, FL 32720-2560
(386) 736-3108
(386) 736-3643
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2674
FL
235Z00000X
Speech-Language Pathologist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
681664996
—
FL
05
—
882094500
—
FL
01
—
R5L
BLUE CROSS & BLUE SHIELD
FL
Enumeration date
06/03/2006
Last updated
09/15/2022
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