Provider Demographics
NPI:1487705950
Name:ASCENSION REHABILITATION PROGRAMS LLC
Entity type:Organization
Organization Name:ASCENSION REHABILITATION PROGRAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:727-278-8050
Mailing Address - Street 1:817 35TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1239
Mailing Address - Country:US
Mailing Address - Phone:727-278-8050
Mailing Address - Fax:727-525-4843
Practice Address - Street 1:817 35TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1239
Practice Address - Country:US
Practice Address - Phone:727-278-8050
Practice Address - Fax:727-525-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9496Medicare ID - Type UnspecifiedGROUP IDENTIFICATION NUMB