Provider Demographics
NPI:1134142516
Name:TEAM REHAB, LLC
Entity Type:Organization
Organization Name:TEAM REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT PHYSICAL THERAP
Authorized Official - Phone:563-382-4770
Mailing Address - Street 1:516 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2720
Mailing Address - Country:US
Mailing Address - Phone:563-382-4770
Mailing Address - Fax:563-382-4785
Practice Address - Street 1:516 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2720
Practice Address - Country:US
Practice Address - Phone:563-382-4770
Practice Address - Fax:563-382-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IATN0100OtherJOHN DEERE
MN8B768TEOtherBLUE CROSS BLUE SHEILD
IA34706OtherBLUE CROSS BLUE SHEILD
IAF245962OtherMIDLANDS CHOICE
IATN0100OtherJOHN DEERE
IAF245962OtherMIDLANDS CHOICE