1104909217 NPI number — REHABILITATIVE ASSOCIATES INC

Table of content: (NPI 1104909217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104909217 NPI number — REHABILITATIVE ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATIVE ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOHICAN SPORT MEDICINE AND REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104909217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 HARCOURT RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43050-3946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-392-8811
Provider Business Mailing Address Fax Number:
740-392-6485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 S LANE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BUCYRUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44820-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-562-6686
Provider Business Practice Location Address Fax Number:
419-562-6625
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
740-392-8811

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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