Provider Demographics
NPI:1447512207
Name:KISSIMMEE LIMITS REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:KISSIMMEE LIMITS REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLASIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-931-1515
Mailing Address - Street 1:1065 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4210
Mailing Address - Country:US
Mailing Address - Phone:407-931-1515
Mailing Address - Fax:401-931-1517
Practice Address - Street 1:1065 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4210
Practice Address - Country:US
Practice Address - Phone:407-931-1515
Practice Address - Fax:401-931-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty