Provider Demographics
NPI:1548237118
Name:TLC REHAB, LLC
Entity Type:Organization
Organization Name:TLC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DREAMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-382-7214
Mailing Address - Street 1:PO BOX 741708
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1708
Mailing Address - Country:US
Mailing Address - Phone:352-382-7214
Mailing Address - Fax:352-382-7781
Practice Address - Street 1:2679 N FOREST RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5123
Practice Address - Country:US
Practice Address - Phone:352-746-2371
Practice Address - Fax:352-746-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X, 225X00000X
225XH1200X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883054108Medicaid
1187840004Medicare NSC
106898Medicare UPIN
FL1187840004Medicare NSC