Provider Demographics
NPI:1306009394
Name:REHAB BY DR LIFRAK
Entity Type:Organization
Organization Name:REHAB BY DR LIFRAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-654-7317
Mailing Address - Street 1:1010 N UNION ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2731
Mailing Address - Country:US
Mailing Address - Phone:302-654-7317
Mailing Address - Fax:
Practice Address - Street 1:1010 N UNION ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2731
Practice Address - Country:US
Practice Address - Phone:302-654-7317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100002238207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty