Healthcare Provider Details

I. General information

NPI: 1932414604
Provider Name (Legal Business Name): COMMUNITY REHAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 NO. 149TH CIRCLE RIDGEWOOD CLUBHOUSE
OMAHA NE
68007
US

IV. Provider business mailing address

12301 N 149 CIRCLE RIDGEWOOD CLUBHOUSE
OMAHA NE
68007
US

V. Phone/Fax

Practice location:
  • Phone: 402-884-7644
  • Fax: 402-884-7525
Mailing address:
  • Phone: 402-884-7644
  • Fax: 402-884-7525

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