Provider Demographics
NPI:1699947465
Name:REHABILITATION CONSULTANTS PA
Entity type:Organization
Organization Name:REHABILITATION CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROGGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-768-5454
Mailing Address - Street 1:PO BOX 60013
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6013
Mailing Address - Country:US
Mailing Address - Phone:239-768-5454
Mailing Address - Fax:239-768-5432
Practice Address - Street 1:13685 DOCTORS WAY
Practice Address - Street 2:STE 190
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4336
Practice Address - Country:US
Practice Address - Phone:239-768-5454
Practice Address - Fax:239-768-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6278208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80647AMedicare PIN
FLF30889Medicare UPIN