Provider Demographics
NPI:1073714010
Name:REGIONAL REHAB ASSOCIATES PA
Entity Type:Organization
Organization Name:REGIONAL REHAB ASSOCIATES PA
Other - Org Name:JAFFE SPORTS MEDICINE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-254-7778
Mailing Address - Street 1:PO BOX 111090
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0119
Mailing Address - Country:US
Mailing Address - Phone:239-254-7778
Mailing Address - Fax:239-254-7718
Practice Address - Street 1:1865 VETERANS PARK DR
Practice Address - Street 2:SUITE# 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0447
Practice Address - Country:US
Practice Address - Phone:239-254-7778
Practice Address - Fax:239-254-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
FLOS8375332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS8375OtherLICENSE
FLOS8375OtherLICENSE
FLK8467Medicare PIN
FL4736770002Medicare NSC