Provider Demographics
NPI:1669581401
Name:COMMUNITY REHAB, INC
Entity type:Organization
Organization Name:COMMUNITY REHAB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:402-721-3908
Mailing Address - Street 1:8002 S 84TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3302
Mailing Address - Country:US
Mailing Address - Phone:402-331-6444
Mailing Address - Fax:402-331-9080
Practice Address - Street 1:8002 S 84TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LAVISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3302
Practice Address - Country:US
Practice Address - Phone:402-331-6444
Practice Address - Fax:402-331-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEN/A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01805OtherBLUE CROSS BLUE SHIELD
NE83270OtherCOVENTRY
NES561OtherMIDLANDS CHOICE
IA0586339Medicaid
NE193153201OtherDOL-OWCP
NE6400076Medicaid
NE6400076Medicaid
IA0586339Medicaid
NE83270OtherCOVENTRY