Provider Demographics
NPI:1477682516
Name:REHAB SPECIALISTS INC. - WINTER HAVEN
Entity Type:Organization
Organization Name:REHAB SPECIALISTS INC. - WINTER HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:MR
Authorized Official - First Name:ACE STERLING
Authorized Official - Middle Name:ROXAS
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:863-701-0606
Mailing Address - Street 1:3625 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4864
Mailing Address - Country:US
Mailing Address - Phone:863-701-0606
Mailing Address - Fax:863-701-0311
Practice Address - Street 1:3625 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4864
Practice Address - Country:US
Practice Address - Phone:863-701-0606
Practice Address - Fax:863-701-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6404225100000X
FLPT5986225100000X
FLPT16026225100000X
FLPT10290225100000X
FLOT5262225X00000X
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
FL102318OtherAVMED
FL5239004OtherAETNA PPO
FL213840OtherAMERIGROUP
FL826886OtherAETNA HMO
FLY910GOtherBCBS
FLY910GOtherBCBS