1770672099 NPI number — REHABILITATIVE ASSOCIATES INC

Table of content: (NPI 1770672099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770672099 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:
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:
1770672099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11177 LAMBS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-763-0408
Provider Business Mailing Address Fax Number:
740-763-0475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
384 COURTLAND LANE
Provider Second Line Business Practice Location Address:
PICKERINGTON RUN PLAZA
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-837-8227
Provider Business Practice Location Address Fax Number:
614-837-9767
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONKLER
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
740-763-0408

Provider Taxonomy Codes

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

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

  • Identifier: 2469529 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com