=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386719052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REA REHABILITATION SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2360 MONTEBELLO SQUARE DR STE C
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-6901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-599-5330
-----------------------------------------------------
Fax | 719-599-5438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2360 MONTEBELLO SQUARE DR STE C
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-6901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-599-5330
-----------------------------------------------------
Fax | 719-599-5438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SCOTT THOMAS REA
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 719-599-5330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------