Provider Demographics
NPI:1871548750
Name:AT HOME REHAB LLC
Entity type:Organization
Organization Name:AT HOME REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LEANORA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:PREMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:719-539-2431
Mailing Address - Street 1:416 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2822
Mailing Address - Country:US
Mailing Address - Phone:719-539-2431
Mailing Address - Fax:719-539-3626
Practice Address - Street 1:731 BLAKE ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2919
Practice Address - Country:US
Practice Address - Phone:719-539-2431
Practice Address - Fax:719-539-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802573Medicare ID - Type UnspecifiedUPIN GROUP NUMBER