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General NPI Number Information
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NPI Number | 1669581401
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Entity Type | Organization
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Legal Business Name | COMMUNITY REHAB, INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 8002 S 84TH ST SUITE 1
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City | LAVISTA
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State | NE
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Zip | 68128-3302
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Country | US
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Telephone | 402-331-6444
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Fax | 402-331-9080
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Provider Business Mailing Address
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Address Line | 8002 S 84TH ST STE 1
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City | LAVISTA
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State | NE
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Zip | 68128-3302
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Country | US
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Telephone | 402-331-6444
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Fax | 402-331-9080
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MARY J THEILER
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Credential | MPT
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Telephone | 402-721-3908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | N/A
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License Number State | NE
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