Provider Demographics
NPI:1295918878
Name:REHAB PROVIDER, INC
Entity type:Organization
Organization Name:REHAB PROVIDER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-925-1082
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-4226
Mailing Address - Country:US
Mailing Address - Phone:731-925-1082
Mailing Address - Fax:731-925-1818
Practice Address - Street 1:984 WAYNE RD STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2346
Practice Address - Country:US
Practice Address - Phone:731-925-1082
Practice Address - Fax:731-925-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN218611OtherUNISON