Provider Demographics
NPI:1801160189
Name:LIGHT REHAB INC
Entity type:Organization
Organization Name:LIGHT REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:954-257-7919
Mailing Address - Street 1:11302 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4503
Mailing Address - Country:US
Mailing Address - Phone:954-257-7919
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:7225 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2908
Practice Address - Country:US
Practice Address - Phone:954-724-3031
Practice Address - Fax:954-963-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3616261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4215AMedicare UPIN