Provider Demographics
NPI:1033173265
Name:PERSONAL REHAB INC
Entity Type:Organization
Organization Name:PERSONAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:863-699-6929
Mailing Address - Street 1:104 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-1808
Mailing Address - Country:US
Mailing Address - Phone:863-699-6929
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-1808
Practice Address - Country:US
Practice Address - Phone:863-699-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0005726208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC0334OtherRAILROAD MEDICARE
FLY909EOtherBLUE CROSS BLUE SHIELD
FLY909EOtherBLUE CROSS BLUE SHIELD