Provider Demographics
NPI:1386647683
Name:THERAPY ONE REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:THERAPY ONE REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BYRL
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:850-763-0603
Mailing Address - Street 1:3210 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4224
Mailing Address - Country:US
Mailing Address - Phone:850-763-0603
Mailing Address - Fax:850-769-5914
Practice Address - Street 1:3210 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4224
Practice Address - Country:US
Practice Address - Phone:850-763-0603
Practice Address - Fax:850-769-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008869200Medicaid
FL008869200Medicaid
FL4552910001Medicare NSC