Provider Demographics
NPI:1598734428
Name:REHAB ASSOCIATES OF WEST FLORIDA
Entity Type:Organization
Organization Name:REHAB ASSOCIATES OF WEST FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-584-4533
Mailing Address - Street 1:901 CLEARWATER LARGO RD N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4126
Mailing Address - Country:US
Mailing Address - Phone:727-584-4533
Mailing Address - Fax:727-581-7386
Practice Address - Street 1:901 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4126
Practice Address - Country:US
Practice Address - Phone:727-584-4533
Practice Address - Fax:727-581-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24320Medicare ID - Type Unspecified