Provider Demographics
NPI:1003990854
Name:TOTAL REHAB, P.C.
Entity Type:Organization
Organization Name:TOTAL REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-917-2020
Mailing Address - Street 1:10920 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2612
Mailing Address - Country:US
Mailing Address - Phone:402-917-2020
Mailing Address - Fax:402-571-3229
Practice Address - Street 1:10920 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2612
Practice Address - Country:US
Practice Address - Phone:402-917-2020
Practice Address - Fax:402-571-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09248OtherBLUE CROSS
NE50766662613Medicaid
NE09248OtherBLUE CROSS