Provider Demographics
NPI:1548379340
Name:PROFESSIONAL CARE REHAB INC
Entity Type:Organization
Organization Name:PROFESSIONAL CARE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-5520
Mailing Address - Street 1:9151 US HIGHWAY 19 NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:727-579-9155
Mailing Address - Fax:
Practice Address - Street 1:9151 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5406
Practice Address - Country:US
Practice Address - Phone:727-579-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686634Medicare ID - Type UnspecifiedPART B REHAB