Provider Demographics
NPI:1578565990
Name:COMMUNITY REHAB, INC
Entity Type:Organization
Organization Name:COMMUNITY REHAB, INC
Other - Org Name:COMMUNITY REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:THEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:402-721-3908
Mailing Address - Street 1:410 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2609
Mailing Address - Country:US
Mailing Address - Phone:402-721-3908
Mailing Address - Fax:402-721-4047
Practice Address - Street 1:410 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2609
Practice Address - Country:US
Practice Address - Phone:402-721-3908
Practice Address - Fax:402-721-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2016-10-19
Deactivation Date:2005-08-17
Deactivation Code:
Reactivation Date:2005-12-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE83270OtherCOVENTRY
NE01805OtherBLUE CROSS BLUE SHIELD
NE193153200OtherDOL-OWCP
IA0586339Medicaid
NES561OtherMIDLANDS CHOICE
NE83270OtherCOVENTRY
IA0586339Medicaid
NE098958Medicare PIN