Provider Demographics
NPI:1861630378
Name:REHAB PROVIDERS INC
Entity Type:Organization
Organization Name:REHAB PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FEARON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-891-0782
Mailing Address - Street 1:1527 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4443
Mailing Address - Country:US
Mailing Address - Phone:904-891-0782
Mailing Address - Fax:904-357-0061
Practice Address - Street 1:1527 SILVER ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4443
Practice Address - Country:US
Practice Address - Phone:904-891-0782
Practice Address - Fax:904-357-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty