Provider Demographics
NPI:1942487640
Name:PASCO C.O.R.F., INC.
Entity Type:Organization
Organization Name:PASCO C.O.R.F., INC.
Other - Org Name:PASCO REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNICKERBOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-521-0002
Mailing Address - Street 1:37104 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5911
Mailing Address - Country:US
Mailing Address - Phone:352-521-0002
Mailing Address - Fax:352-521-5958
Practice Address - Street 1:37104 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5911
Practice Address - Country:US
Practice Address - Phone:352-521-0002
Practice Address - Fax:352-521-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106763Medicare Oscar/Certification