1639175474 NPI number — REHABILITATION AQUATICS AND PHYSICAL THERAPY, INC.

Table of content: (NPI 1639175474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639175474 NPI number — REHABILITATION AQUATICS AND PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION AQUATICS AND PHYSICAL THERAPY, 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:
1639175474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3130 CENTRAL PARK W
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43617-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-841-9622
Provider Business Mailing Address Fax Number:
419-843-8288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3130 CENTRAL PARK W
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43617-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-841-9622
Provider Business Practice Location Address Fax Number:
419-843-8288
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BINKLEY
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
419-841-9622

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  03396 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 01872 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 03101 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0742647 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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