Provider Demographics
NPI:1932643780
Name:FLORIDA REHABILITY AT HOME, LLC
Entity Type:Organization
Organization Name:FLORIDA REHABILITY AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:302-304-9729
Mailing Address - Street 1:1591 LOCKMEADE PL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5120
Mailing Address - Country:US
Mailing Address - Phone:302-304-9729
Mailing Address - Fax:888-509-1710
Practice Address - Street 1:1591 LOCKMEADE PL
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-5120
Practice Address - Country:US
Practice Address - Phone:302-304-9729
Practice Address - Fax:888-509-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19839225100000X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty