Provider Demographics
NPI:1447236674
Name:INEX THERAPEUTIC & REHABILITATION
Entity Type:Organization
Organization Name:INEX THERAPEUTIC & REHABILITATION
Other - Org Name:INEX PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:850-476-4774
Mailing Address - Street 1:4501 N DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2770
Mailing Address - Country:US
Mailing Address - Phone:850-476-4774
Mailing Address - Fax:850-476-3031
Practice Address - Street 1:4501 N DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2770
Practice Address - Country:US
Practice Address - Phone:850-476-4774
Practice Address - Fax:850-476-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR2FOtherBLUE CROSS PROVIDER
FL106783Medicare ID - Type UnspecifiedPROVIDER NUMBER