Provider Demographics
NPI:1083819700
Name:REHAB HEALTH PARTNERS LAKE WALES
Entity Type:Organization
Organization Name:REHAB HEALTH PARTNERS LAKE WALES
Other - Org Name:REHAB HEALTH PARTNERS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-687-0931
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33802-1838
Mailing Address - Country:US
Mailing Address - Phone:863-679-7833
Mailing Address - Fax:863-679-1532
Practice Address - Street 1:1112 DRUID CIR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4307
Practice Address - Country:US
Practice Address - Phone:863-679-7833
Practice Address - Fax:863-679-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRL5OtherBCBS PROVIDER NUMBER
FL68-6655Medicare ID - Type UnspecifiedMEDICARE