Provider Demographics
NPI:1871580969
Name:MEDICAL REHABILITATION ASSOCIATES, INC PC
Entity type:Organization
Organization Name:MEDICAL REHABILITATION ASSOCIATES, INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-809-5312
Mailing Address - Street 1:1964 HOWELL BRANCH RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1042
Mailing Address - Country:US
Mailing Address - Phone:407-681-2241
Mailing Address - Fax:407-279-6779
Practice Address - Street 1:6086 AUBURN CT
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8022
Practice Address - Country:US
Practice Address - Phone:304-809-5312
Practice Address - Fax:410-250-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0113641000Medicaid
KY7100210600Medicaid
KY7100210600Medicaid