Provider Demographics
NPI:1871747386
Name:M & M REHAB., INC.
Entity type:Organization
Organization Name:M & M REHAB., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:352-331-3399
Mailing Address - Street 1:2300 SE 17TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9140
Mailing Address - Country:US
Mailing Address - Phone:352-352-3207
Mailing Address - Fax:352-351-3267
Practice Address - Street 1:601 E DIXIE AVE STE 806
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5994
Practice Address - Country:US
Practice Address - Phone:352-435-4500
Practice Address - Fax:352-435-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001641300Medicaid