Provider Demographics
NPI:1417007725
Name:REHAB KINETICS INC
Entity Type:Organization
Organization Name:REHAB KINETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:352-592-0010
Mailing Address - Street 1:11535 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-7373
Mailing Address - Country:US
Mailing Address - Phone:352-592-0010
Mailing Address - Fax:352-592-0011
Practice Address - Street 1:11535 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7373
Practice Address - Country:US
Practice Address - Phone:352-592-0010
Practice Address - Fax:352-592-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010736225100000X
FLPT13514225100000X
FLPT21267225100000X
FLPTA19025225200000X
FLPTA1172225200000X
FLPTA20103225200000X
FLSA3137235Z00000X
FLSA8079235Z00000X
FLSZ3883235Z00000X
FLSA556235Z00000X
FLSA3315235Z00000X
FLSA3275235Z00000X
FLSZ2535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQS4OtherBCBS GROUP NUMBER
FL886048300Medicaid
FL886048300Medicaid