Provider Demographics
NPI:1295124329
Name:ADVANCED REHAB SPECIALTIES P.A.
Entity type:Organization
Organization Name:ADVANCED REHAB SPECIALTIES P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:ALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-530-6676
Mailing Address - Street 1:616 N PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4417
Mailing Address - Country:US
Mailing Address - Phone:352-702-0850
Mailing Address - Fax:352-530-2476
Practice Address - Street 1:616 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4417
Practice Address - Country:US
Practice Address - Phone:352-702-0850
Practice Address - Fax:352-530-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053190991OtherCMS NPI REGISTRY
FL660209600OtherRURAL MEDICAID GROUP
FL1497955611OtherCMS NPI REGISTRY
FL108973OtherRURAL MEDICARE GROUP
FL1407893571OtherCMS NPI REGISTRY
FL1932199197OtherCMS NPI REGISTRY
FLP08228OtherMEDICARE UPIN
FL303171300Medicaid