Provider Demographics
NPI:1720240435
Name:SUN RISE REHABILITATION
Entity Type:Organization
Organization Name:SUN RISE REHABILITATION
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NED
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-331-1497
Mailing Address - Street 1:1332 N POMPANO AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3733
Mailing Address - Country:US
Mailing Address - Phone:941-331-1497
Mailing Address - Fax:
Practice Address - Street 1:1332 N POMPANO AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3733
Practice Address - Country:US
Practice Address - Phone:941-331-1497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19755374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4860AOtherSUPPLIER NUMBER FOR PHYSICAL THERAPY MEDICARE GROUP PART B
FLU4860AMedicare UPIN