Provider Demographics
NPI:1063015055
Name:COLONIAL POST REHAB CENTER
Entity Type:Organization
Organization Name:COLONIAL POST REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:786-320-0907
Mailing Address - Street 1:2675 WINKLER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9383
Mailing Address - Country:US
Mailing Address - Phone:786-320-0907
Mailing Address - Fax:
Practice Address - Street 1:2675 WINKLER AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9383
Practice Address - Country:US
Practice Address - Phone:786-320-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation