Healthcare Provider Details

I. General information

NPI: 1174327100
Provider Name (Legal Business Name): CITRUS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 NE 1ST ST
CRYSTAL RIVER FL
34429-4301
US

IV. Provider business mailing address

639 NE 1ST ST
CRYSTAL RIVER FL
34429-4301
US

V. Phone/Fax

Practice location:
  • Phone: 352-219-7173
  • Fax: 352-563-2438
Mailing address:
  • Phone: 352-219-7173
  • Fax: 352-563-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARIN LASTINGER
Title or Position: PRESIDENT
Credential:
Phone: 352-219-7173