Provider Demographics
NPI:1841416823
Name:ABC PEDIATRIC REHAB SERVICES, INC.
Entity Type:Organization
Organization Name:ABC PEDIATRIC REHAB SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:407-399-2211
Mailing Address - Street 1:1215 BAY ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4203
Mailing Address - Country:US
Mailing Address - Phone:407-399-2211
Mailing Address - Fax:407-932-3871
Practice Address - Street 1:1215 BAY ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4203
Practice Address - Country:US
Practice Address - Phone:407-399-2211
Practice Address - Fax:407-932-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT64082251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty