Provider Demographics
NPI:1649326034
Name:COMMUNITY REHAB ASSOCIATES, INC..
Entity type:Organization
Organization Name:COMMUNITY REHAB ASSOCIATES, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:727-896-8086
Mailing Address - Street 1:3950 3RD ST N
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-6123
Mailing Address - Country:US
Mailing Address - Phone:727-896-8086
Mailing Address - Fax:727-896-1017
Practice Address - Street 1:3950 3RD ST N
Practice Address - Street 2:SUITE D
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-6123
Practice Address - Country:US
Practice Address - Phone:727-896-8086
Practice Address - Fax:727-896-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110976OtherCITRUS HEALTHCARE
FL278346OtherAMERIGROUP PROVIDER ID
FLT0864OtherBCBS OUT OF NETWORK
FL=========OtherCHILDREN'S MED SVCS
FL278346OtherAMERIGROUP PROVIDER ID