1043350481 NPI number — REHAB ENGINEERING LLC

Table of content: (NPI 1043350481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043350481 NPI number — REHAB ENGINEERING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB ENGINEERING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043350481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1719 MAHAN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-656-3599
Provider Business Mailing Address Fax Number:
850-656-6483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 BEMISS ROAD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-241-2005
Provider Business Practice Location Address Fax Number:
229-241-9778
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREDRICK
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-656-3599

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  POR 28 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 014 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 746347392A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com