MEDICARE: COMMUNITY REHAB, 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	225100000X	Physical Therapist	N/A	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01805	OTHER	NE	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	S561	OTHER	NE	MIDLANDS CHOICE
5	193153205	OTHER	NE	DOL-OWCP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	83270	OTHER	NE	COVENTRY

General Provider Information

NPI Number	:	1285743021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY REHAB, INC.

Provider Business Mailing Address
First Line	:	14450 EAGLE RUN DR STE 130
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-504-1330
Fax Number	:	402-504-1335

Provider Business Practice Location Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	SUITE 130
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-504-1330
Fax Number	:	402-504-1335

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MARY J THEILER
Credential	:	MPT
Telephone Number	:	402-721-3908

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	05/16/2008

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Directions to “COMMUNITY REHAB, INC. ” Practice Location

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