MEDICARE: VENICE REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9A	OTHER	FL	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1447251947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENICE REHAB, LLC

Provider Business Mailing Address
First Line	:	PO BOX 632649
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2649
Country	:	US
Telephone Number	:	941-408-0670
Fax Number	:	941-408-0160

Provider Business Practice Location Address
First Line	:	2203 S TAMIAMI TRL
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5016
Country	:	US
Telephone Number	:	941-408-0670
Fax Number	:	941-408-0160

Authorized Official
Title or Position	:	CHIEF CLINICAL OFFICER
Name	:	ERIC ELDON DOUGLASS
Credential	:
Telephone Number	:	941-870-4401

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/21/2025

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Directions to “VENICE REHAB, LLC ” Practice Location

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