1154729366 NPI number — PHOENIX REHABILITATION AND HEALTH SERVICES, INC.

Table of content: DR. TARA OKEEFFE BERAN PT, DPT (NPI 1366494064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154729366 NPI number — PHOENIX REHABILITATION AND HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX REHABILITATION AND HEALTH SERVICES, 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:
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:
1154729366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392573
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-9573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-584-5739
Provider Business Mailing Address Fax Number:
724-343-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 UNION AVE
Provider Second Line Business Practice Location Address:
PLAZA ONE, SUITE D
Provider Business Practice Location Address City Name:
NATRONA HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15065-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-224-5090
Provider Business Practice Location Address Fax Number:
724-224-5093
Provider Enumeration Date:
12/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, RCM SUPPORT
Authorized Official Telephone Number:
412-339-1063

Provider Taxonomy Codes

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

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

  • Identifier: 1019541330001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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