Basic Information
| Provider Information | |||||||||
| NPI: | 1578757878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARASOTA REHAB ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 EDGELAKE DRIVE | ||||||||
| Address2: | HEALTHSOUTH REHAB HOSPITAL OF SARASOTA | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419218645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6400 EDGELAKE DRIVE | ||||||||
| Address2: | HEALTHSOUTH REHAB HOSPITAL OF SARASOTA | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419218645 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEJESUS | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9419218645 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME0077137 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 258701700 | 05 | FL | MEDICAID |