Provider Demographics
NPI:1326273921
Name:COMMUNITY REHAB PT
Entity Type:Organization
Organization Name:COMMUNITY REHAB PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEILER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-721-3908
Mailing Address - Street 1:7902 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3631
Mailing Address - Country:US
Mailing Address - Phone:402-393-2294
Mailing Address - Fax:402-393-2754
Practice Address - Street 1:7902 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3631
Practice Address - Country:US
Practice Address - Phone:402-393-2294
Practice Address - Fax:402-393-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty