1144347204 NPI number — THE REHAB ZONE, INC.

Table of content: (NPI 1144347204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144347204 NPI number — THE REHAB ZONE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE REHAB ZONE, 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:
Provider Other Organization Name Type Code:
6
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:
1144347204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 KIMBALL AVE STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05403-6840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-497-0690
Provider Business Mailing Address Fax Number:
802-497-0923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05478-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-309-0430
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAAS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
YOUNG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-497-0690

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  040-0003160 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145444879 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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