Provider Demographics
NPI:1518577089
Name:INJURY AND REHAB CENTERS OF CENTRAL FLORIDA, LLC
Entity type:Organization
Organization Name:INJURY AND REHAB CENTERS OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:VON BARGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:407-450-6991
Mailing Address - Street 1:1008 JULIETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6500
Mailing Address - Country:US
Mailing Address - Phone:407-450-6991
Mailing Address - Fax:
Practice Address - Street 1:2500 CITRUS BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3063
Practice Address - Country:US
Practice Address - Phone:407-450-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty