Provider Demographics
NPI:1710342290
Name:REHABILITY, LLC
Entity Type:Organization
Organization Name:REHABILITY, LLC
Other - Org Name:REHABILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:L/CPO
Authorized Official - Phone:352-701-0494
Mailing Address - Street 1:11216 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4650
Mailing Address - Country:US
Mailing Address - Phone:352-701-0494
Mailing Address - Fax:352-701-0493
Practice Address - Street 1:11216 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609
Practice Address - Country:US
Practice Address - Phone:352-701-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 191261QA0900X
FLOT 11205261QP2000X, 261QR0400X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No335E00000XSuppliersProsthetic/Orthotic Supplier