Healthcare Provider Details

I. General information

NPI: 1215273339
Provider Name (Legal Business Name): COMMUNITY REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 DODGE ST FH 026
OMAHA NE
68182-1102
US

IV. Provider business mailing address

119 N 51ST ST #101
OMAHA NE
68132-2867
US

V. Phone/Fax

Practice location:
  • Phone: 402-554-3112
  • Fax: 402-554-3381
Mailing address:
  • Phone: 402-506-5695
  • Fax: 402-506-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY J THEILER
Title or Position: OWNER
Credential: PT
Phone: 402-721-3908