Provider Demographics
NPI:1669460044
Name:TEAMWORK REHAB SERVICES
Entity Type:Organization
Organization Name:TEAMWORK REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLOTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARACUT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:800-708-9656
Mailing Address - Street 1:1206 ROYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4016
Mailing Address - Country:US
Mailing Address - Phone:800-708-9656
Mailing Address - Fax:
Practice Address - Street 1:1206 ROYCROFT AVE
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4016
Practice Address - Country:US
Practice Address - Phone:800-708-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8825247200Medicaid
FLK1665Medicare ID - Type UnspecifiedGROUP PROVIDER