Provider Demographics
NPI:1629854799
Name:SOUTH FLORIDA NEURO REHAB, LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA NEURO REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROENCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-662-5863
Mailing Address - Street 1:8645 N MILITARY TRL STE 401
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6295
Mailing Address - Country:US
Mailing Address - Phone:561-320-2702
Mailing Address - Fax:
Practice Address - Street 1:8645 N MILITARY TRL STE 401
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6295
Practice Address - Country:US
Practice Address - Phone:561-320-2702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy