NPIMap

Organization Active NPI

Shine Rehab Inc

  • Physical Therapy Clinic/Center
  • Port Charlotte, FL
National Provider Identifier
1245533959
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT10614 Issued in FL
Legal business name
SHINE REHAB INC
Practice address
2301 Tamiami TRL
Suite C
Port Charlotte, FL 33952-3907
Phone
(941) 625-1252
Fax
(941) 625-0616
NPI assigned
Dec 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rowena Cabading Mercado, PTNPI 1376029553
Title
Vice President
Phone
(941) 625-1252

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT10614 FL Primary

Addresses

Primary practice location

2301 Tamiami TRL
Suite C
Port Charlotte, FL 33952-3907

Mailing address

2301 Tamiami Trail
Suite C
Port Charlotte, FL 33952
Phone (941) 625-1252

National Provider Directory

National Provider Directory
Tax ID family
Shinerehab Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2301 Tamiami Trl
Ste C
Pt Charlotte, FL 33952
Phone (941) 204-1515

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1245533959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 TAMIAMI TRAIL",
            "address_2": "SUITE C",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33952",
            "telephone_number": "941-625-1252",
            "fax_number": "941-625-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 TAMIAMI TRL",
            "address_2": "SUITE C",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339523907",
            "telephone_number": "941-625-1252",
            "fax_number": "941-625-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-20",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "ROWENA",
        "authorized_official_middle_name": "CABADING",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "941-625-1252",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT10614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.