Basic Information
| Provider Information | |||||||||
| NPI: | 1730361247 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REHABILITATION AND HEALTH CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THERAPY SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BAKER BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308651600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 27600 CHAGRIN BLVD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308651600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | PORTERFIELD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3305644100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REHABILITATION AND HEALTH CENTER, INC | ||||||||
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| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2706156 | 05 | OH | MEDICAID |