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	193153202	OTHER	NE	DOL-OWCP
2	01805	OTHER	NE	BLUE CROSS BLUE SHIELD
3	S561	OTHER	NE	MIDLANDS CHOICE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	83270	OTHER	NE	COVENTRY

General Provider Information

NPI Number	:	1376652115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY REHAB, INC

Provider Business Mailing Address
First Line	:	2380 8TH AVE STE 8
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2367
Country	:	US
Telephone Number	:	402-296-3433
Fax Number	:	402-296-3531

Provider Business Practice Location Address
First Line	:	2380 8TH AVE
Second Line	:	SUITE 8
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2367
Country	:	US
Telephone Number	:	402-296-3433
Fax Number	:	402-296-3531

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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1033340724 — ANDREA JAE CARDA O.D.
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Directions to “COMMUNITY REHAB, INC ” Practice Location

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