MEDICARE: REHAB FRONTIER, LLC

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y922K	OTHER	FL	BCBSFL PROVIDER NUMBER

General Provider Information

NPI Number	:	1285650648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB FRONTIER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1168
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-1168
Country	:	US
Telephone Number	:	863-678-1557
Fax Number	:	863-582-9279

Provider Business Practice Location Address
First Line	:	2027 STATE ROAD 60 E
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33898-5113
Country	:	US
Telephone Number	:	863-678-1557
Fax Number	:	863-582-9279

Authorized Official
Title or Position	:	CHIEF MANAGER
Name	:	LOWELL S LIWANAG
Credential	:	RPT, WCC, CWS
Telephone Number	:	863-605-3681

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/17/2008

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Directions to “REHAB FRONTIER, LLC ” Practice Location

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