Provider Demographics
NPI:1578757878
Name:SARASOTA REHAB ASSOCIATES INC
Entity Type:Organization
Organization Name:SARASOTA REHAB ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-921-8645
Mailing Address - Street 1:6400 EDGELAKE DRIVE
Mailing Address - Street 2:HEALTHSOUTH REHAB HOSPITAL OF SARASOTA
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8813
Mailing Address - Country:US
Mailing Address - Phone:941-921-8645
Mailing Address - Fax:
Practice Address - Street 1:6400 EDGELAKE DRIVE
Practice Address - Street 2:HEALTHSOUTH REHAB HOSPITAL OF SARASOTA
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8813
Practice Address - Country:US
Practice Address - Phone:941-921-8645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077137208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258701700Medicaid
44664Medicare PIN
FL258701700Medicaid