Provider Demographics
NPI:1710912373
Name:REALHAB INC
Entity Type:Organization
Organization Name:REALHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-776-5585
Mailing Address - Street 1:14400 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-7400
Mailing Address - Country:US
Mailing Address - Phone:941-776-1290
Mailing Address - Fax:941-776-2528
Practice Address - Street 1:12159 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8678
Practice Address - Country:US
Practice Address - Phone:941-776-5585
Practice Address - Fax:941-776-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202642733OtherTRICARE
FLY90T6OtherBLUE CROSS BLUE SHIELD
FLY012HOtherBLUE CROSS BLUE SHIELD
FL=========OtherOTHER COMMERCIAL (EIN)
FL202642733OtherTRICARE