Provider Demographics
NPI:1053524850
Name:CENTRAL FLORIDA MEDICAL &REHAB CENTER INC
Entity type:Organization
Organization Name:CENTRAL FLORIDA MEDICAL &REHAB CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORSUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-263-3038
Mailing Address - Street 1:320 PINEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3806
Mailing Address - Country:US
Mailing Address - Phone:407-263-3038
Mailing Address - Fax:407-263-3079
Practice Address - Street 1:320 PINEY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707
Practice Address - Country:US
Practice Address - Phone:407-263-3038
Practice Address - Fax:407-263-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4523261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC4051OtherBLUE CROSS BLUE SHEILD
FL647162OtherU.H.C
FL647162OtherU.H.C
FLU50237Medicare UPIN