Provider Demographics
NPI:1457438236
Name:ABBEY REHABILITATION SPECIALISTS OF LAKE COUNTY INC
Entity Type:Organization
Organization Name:ABBEY REHABILITATION SPECIALISTS OF LAKE COUNTY INC
Other - Org Name:VILLAGE REHABILITATION SPECIALISTS OF LADY LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-787-0669
Mailing Address - Street 1:607 HIGHWAY 466
Mailing Address - Street 2:A
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3792
Mailing Address - Country:US
Mailing Address - Phone:352-787-0669
Mailing Address - Fax:352-360-1727
Practice Address - Street 1:607 HIGHWAY 466
Practice Address - Street 2:A
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3792
Practice Address - Country:US
Practice Address - Phone:352-787-0669
Practice Address - Fax:352-360-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7137Medicare ID - Type UnspecifiedGROUP PROVIDER