Provider Demographics
NPI:1407278864
Name:COMMUNITY REHAB INC
Entity Type:Organization
Organization Name:COMMUNITY REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-614-7775
Mailing Address - Street 1:4500 S 70TH ST
Mailing Address - Street 2:#115
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4283
Mailing Address - Country:US
Mailing Address - Phone:402-817-1784
Mailing Address - Fax:402-264-9611
Practice Address - Street 1:4500 S 70TH ST
Practice Address - Street 2:#115
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4283
Practice Address - Country:US
Practice Address - Phone:402-817-1784
Practice Address - Fax:402-264-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-19
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEPENDINGOtherNEBRASKA MEDICAID
NECH3115OtherRR MEDICARE
NE098958Medicare PIN