Basic Information
| Provider Information | |||||||||
| NPI: | 1932380409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB ENGINEERING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 789 SHERMAN RD | ||||||||
| Address2: | |||||||||
| City: | CAIRO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398288451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506563599 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Practice Location | |||||||||
| Address1: | 1719 MAHAN DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506563599 | ||||||||
| FaxNumber: | 8507692366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | FREDRICK | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CPO | ||||||||
| AuthorizedOfficialTelephone: | 8506563599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | POR28 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.