Provider Demographics
NPI:1285650648
Name:REHAB FRONTIER, LLC
Entity Type:Organization
Organization Name:REHAB FRONTIER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIWANAG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, WCC, CWS
Authorized Official - Phone:863-605-3681
Mailing Address - Street 1:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-1168
Mailing Address - Country:US
Mailing Address - Phone:863-678-1557
Mailing Address - Fax:863-582-9279
Practice Address - Street 1:2027 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-5113
Practice Address - Country:US
Practice Address - Phone:863-678-1557
Practice Address - Fax:863-582-9279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-04-17
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
FLY922KOtherBCBSFL PROVIDER NUMBER
FLK8979Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER