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Organization
MEDICAL REHAB CLINIC OF BROWARD LLC
Active
Organization
MEDICAL REHAB CLINIC OF BROWARD LLC
Active
Other names
Medical Rehab Clinic of Broward
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES HARRY RICHARD D.O. (MEDICAL DIRECTOR)
(954) 467-8855
Entity
Organization
Contact information
Practice address
1528 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1036
(954) 467-8855
(954) 467-8857
Mailing address
1528 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1036
(954) 467-8855
(954) 467-8857
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS8590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001414000
—
FL
01
—
U2206X
MEDICARE PTAN
—
Enumeration date
08/03/2006
Last updated
11/19/2012
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