Provider Demographics
NPI:1760564413
Name:SOUTHEAST REHABILITATION ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SOUTHEAST REHABILITATION ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-679-1400
Mailing Address - Street 1:231 WEAVER ST
Mailing Address - Street 2:UNIT F
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1338
Mailing Address - Country:US
Mailing Address - Phone:508-679-1400
Mailing Address - Fax:508-679-1449
Practice Address - Street 1:231 WEAVER ST
Practice Address - Street 2:UNIT F
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1338
Practice Address - Country:US
Practice Address - Phone:508-679-1400
Practice Address - Fax:508-679-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21402Medicare UPIN