Provider Demographics
NPI:1851454854
Name:FUNCTIONAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:FUNCTIONAL REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:POMPILE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-372-9251
Mailing Address - Street 1:PO BOX 810835
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-0835
Mailing Address - Country:US
Mailing Address - Phone:561-372-9251
Mailing Address - Fax:561-372-9251
Practice Address - Street 1:3416 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3227
Practice Address - Country:US
Practice Address - Phone:561-994-8434
Practice Address - Fax:561-989-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY915TOtherBCBS PROVIDER #