Provider Demographics
NPI:1639143357
Name:MID AMERICA REHAB, P.C.
Entity type:Organization
Organization Name:MID AMERICA REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT,CHT
Authorized Official - Phone:573-339-5989
Mailing Address - Street 1:3047 WILLIAM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6569
Mailing Address - Country:US
Mailing Address - Phone:573-339-5989
Mailing Address - Fax:573-339-7092
Practice Address - Street 1:3047 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6393
Practice Address - Country:US
Practice Address - Phone:573-339-5989
Practice Address - Fax:573-339-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO578069601Medicaid
MO326581OtherHEALTHLINK
MO31376OtherBLUE CROSS
MO326581OtherHEALTHLINK
MO578069601Medicaid
MO5459670001Medicare NSC