Provider Demographics
NPI:1417227067
Name:REHAB PLUS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:REHAB PLUS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-215-0007
Mailing Address - Street 1:5620B CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6734
Mailing Address - Country:US
Mailing Address - Phone:850-215-0007
Mailing Address - Fax:850-215-0006
Practice Address - Street 1:5620B CHERRY ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-6734
Practice Address - Country:US
Practice Address - Phone:850-215-0007
Practice Address - Fax:850-215-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty