Healthcare Provider Details

I. General information

NPI: 1710342290
Provider Name (Legal Business Name): REHABILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11216 SPRING HILL DR
SPRING HILL FL
34609
US

IV. Provider business mailing address

11216 SPRING HILL DR
SPRING HILL FL
34609-4650
US

V. Phone/Fax

Practice location:
  • Phone: 352-701-0494
  • Fax:
Mailing address:
  • Phone: 352-701-0494
  • Fax: 352-701-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT 11205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOT 11205
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License NumberPOR 191
License Number StateFL

VIII. Authorized Official

Name: ARTHUR GAGNE
Title or Position: MANAGING MEMBER
Credential: L/CPO
Phone: 352-701-0494