Basic Information
Provider Information | |||||||||
NPI: | 1053597435 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REHAB & INDUSTRIAL SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | REHAB SERVICES OF NEVADA - ELKO | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5855 BROOKE DR | ||||||||
Address2: |   | ||||||||
City: | WINNEMUCCA | ||||||||
State: | NV | ||||||||
PostalCode: | 894456151 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7757382925 | ||||||||
FaxNumber: | 7756251131 | ||||||||
Practice Location | |||||||||
Address1: | 2001 ERRECART BLVD | ||||||||
Address2: |   | ||||||||
City: | ELKO | ||||||||
State: | NV | ||||||||
PostalCode: | 898018333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7757382925 | ||||||||
FaxNumber: | 7757387395 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/15/2008 | ||||||||
LastUpdateDate: | 08/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GRAY | ||||||||
AuthorizedOfficialFirstName: | DEMARAH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
AuthorizedOfficialTelephone: | 7757382925 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DPT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.