MEDICARE: REHABILITATION CENTER OF ST PETERSBURG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10 5772	OTHER	FL	PART A MEDICARE PROVIDER#

General Provider Information

NPI Number	:	1215188263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABILITATION CENTER OF ST PETERSBURG INC

Provider Business Mailing Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-822-1871
Fax Number	:	727-894-0836

Provider Business Practice Location Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-822-1871
Fax Number	:	727-894-0836

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN EARL WARREN
Credential	:
Telephone Number	:	727-822-1871

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	09/12/2011

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