Healthcare Provider Details

I. General information

NPI: 1407278864
Provider Name (Legal Business Name): COMMUNITY REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2014
Last Update Date: 01/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S 70TH ST #115
LINCOLN NE
68516-4283
US

IV. Provider business mailing address

4500 S 70TH ST #115
LINCOLN NE
68516-4283
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-1784
  • Fax: 402-264-9611
Mailing address:
  • Phone: 402-817-1784
  • Fax: 402-264-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PHILIP D DAVIDSON
Title or Position: OWNER
Credential: PT
Phone: 402-614-7775