Provider Demographics
NPI:1528359288
Name:REHAB ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REHAB ASSOCIATES, LLC
Other - Org Name:CHAMPION SPORTS MEDICINE & REHABILITATION CNTR - FAIRHOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:FLECK
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-467-8705
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-5245
Mailing Address - Country:US
Mailing Address - Phone:724-465-3496
Mailing Address - Fax:215-413-4682
Practice Address - Street 1:908 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2952
Practice Address - Country:US
Practice Address - Phone:251-517-3304
Practice Address - Fax:251-517-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL016579Medicare Oscar/Certification