Provider Demographics
NPI:1922190792
Name:REGIONAL REHABILITATION SERVICES PA
Entity Type:Organization
Organization Name:REGIONAL REHABILITATION SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CORRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:727-942-9040
Mailing Address - Street 1:4705 ALT 19
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1440
Mailing Address - Country:US
Mailing Address - Phone:727-942-9040
Mailing Address - Fax:727-942-9210
Practice Address - Street 1:4705 ALT 19
Practice Address - Street 2:SUITE A
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1440
Practice Address - Country:US
Practice Address - Phone:727-942-9040
Practice Address - Fax:727-942-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8071261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-6888Medicare ID - Type Unspecified