Provider Demographics
NPI:1861493355
Name:AMERICAN MEDICAL REHAB, INC
Entity Type:Organization
Organization Name:AMERICAN MEDICAL REHAB, INC
Other - Org Name:MEDICAL REHAB, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESIA
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:OWENSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-731-0110
Mailing Address - Street 1:4545-2 ST. AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-731-0110
Mailing Address - Fax:904-731-0121
Practice Address - Street 1:4545 SAINT AUGUSTINE RD
Practice Address - Street 2:2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7229
Practice Address - Country:US
Practice Address - Phone:904-731-0110
Practice Address - Fax:904-731-0121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12536000002332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1185220001Medicare ID - Type UnspecifiedMEDICARE