Basic Information
| Provider Information | |||||||||
| NPI: | 1649326034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY REHAB ASSOCIATES, INC.. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 3RD ST N | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337036123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278968086 | ||||||||
| FaxNumber: | 7278961017 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 3RD ST N | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337036123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278968086 | ||||||||
| FaxNumber: | 7278961017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCDONNELL | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7278968086 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 320900000X | X | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 110976 | 01 | FL | CITRUS HEALTHCARE | OTHER | 278346 | 01 | FL | AMERIGROUP PROVIDER ID | OTHER | T0864 | 01 | FL | BCBS OUT OF NETWORK | OTHER |