Provider Demographics
NPI:1982612503
Name:SKILLED REHAB, INC.
Entity type:Organization
Organization Name:SKILLED REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONTOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-949-0003
Mailing Address - Street 1:1900 HIGHLAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7323
Mailing Address - Country:US
Mailing Address - Phone:813-949-0003
Mailing Address - Fax:813-994-0302
Practice Address - Street 1:1900 HIGHLAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7323
Practice Address - Country:US
Practice Address - Phone:813-949-0003
Practice Address - Fax:813-994-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06654OtherUNIVERSAL PROVIDER#
FL6482491OtherUHC PROVIDER #
FLY921ROtherBCBS PROVIDER #
FL06654OtherUNIVERSAL PROVIDER#
FL6482491OtherUHC PROVIDER #