Provider Demographics
NPI:1982707584
Name:INNOVATIVE REHAB CARE INC
Entity Type:Organization
Organization Name:INNOVATIVE REHAB CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:LISSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:850-219-7826
Mailing Address - Street 1:2286-1 WEDNESDAY STREET
Mailing Address - Street 2:INNOVATIVE REHAB CARE
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-219-7826
Mailing Address - Fax:850-383-1322
Practice Address - Street 1:2286-1 WEDNESDAY STREET
Practice Address - Street 2:INNOVATIVE REHAB CARE
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-219-7826
Practice Address - Fax:850-383-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8395225100000X, 225700000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage 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
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1452Medicare ID - Type Unspecified