Provider Demographics
NPI:1467458349
Name:TOTAL REHAB, INC
Entity Type:Organization
Organization Name:TOTAL REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-648-0099
Mailing Address - Street 1:4406 S FLORIDA AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2182
Mailing Address - Country:US
Mailing Address - Phone:863-648-0099
Mailing Address - Fax:863-648-4642
Practice Address - Street 1:4406 S FLORIDA AVE
Practice Address - Street 2:STE 16
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2182
Practice Address - Country:US
Practice Address - Phone:863-648-0099
Practice Address - Fax:863-648-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686545Medicare ID - Type Unspecified