Provider Demographics
NPI:1093824831
Name:COMMUNITY REHAB, INC
Entity Type:Organization
Organization Name:COMMUNITY REHAB, INC
Other - Org Name:COMMUNITY REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:402-721-3908
Mailing Address - Street 1:1103 GALVIN ROAD SOUTH AREA A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005
Mailing Address - Country:US
Mailing Address - Phone:402-408-0890
Mailing Address - Fax:402-408-0892
Practice Address - Street 1:1103 GALVIN RD SOUTH AREA A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3002
Practice Address - Country:US
Practice Address - Phone:402-408-0890
Practice Address - Fax:402-408-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEN/A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES561OtherMIDLANDS CHOICE
NE83270OtherCOVENTRY
NE193153204OtherDOL-OWCP
NE6400338Medicaid
NE01805OtherBLUE CROSS BLUE SHIELD
IA0586339Medicaid
NE193153204OtherDOL-OWCP
NECH3115Medicare ID - Type UnspecifiedRAILROAD MCARE
NES561OtherMIDLANDS CHOICE