Provider Demographics
NPI:1649392903
Name:REHAB DIRECT
Entity Type:Organization
Organization Name:REHAB DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:904-525-0635
Mailing Address - Street 1:470 SPARROW BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5488
Mailing Address - Country:US
Mailing Address - Phone:904-525-0635
Mailing Address - Fax:
Practice Address - Street 1:470 SPARROW BRANCH CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-5488
Practice Address - Country:US
Practice Address - Phone:904-525-0635
Practice Address - Fax:904-287-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 235Z00000X
FLOT11540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889819700Medicaid