=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700038668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHAB ACTION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2008
-----------------------------------------------------
Last Update Date | 08/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8401 CAROLYN DR
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-207-8399
-----------------------------------------------------
Fax | 727-232-0685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8401 CAROLYN DR
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-207-8399
-----------------------------------------------------
Fax | 727-232-0685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GASPARD ALBERT JEAN DE LAAF
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 727-207-8399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 11918
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------