Healthcare Provider Details

I. General information

NPI: 1083887418
Provider Name (Legal Business Name): REHAB CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY
MEXICO MO
65265-3379
US

IV. Provider business mailing address

1 VETERANS WAY
MEXICO MO
65265-3379
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-1088
  • Fax: 573-582-7111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number116687
License Number StateMO

VIII. Authorized Official

Name: RAMONA ELAINE HEISLER
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 573-581-1088