Provider Demographics
NPI:1225355258
Name:COLONIAL REHAB CENTER INC
Entity Type:Organization
Organization Name:COLONIAL REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CECCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-275-3330
Mailing Address - Street 1:4531 DE LEON ST
Mailing Address - Street 2:205 A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-275-3330
Mailing Address - Fax:239-275-3339
Practice Address - Street 1:4531 DE LEON ST
Practice Address - Street 2:205 A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-275-3330
Practice Address - Fax:239-275-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty