Basic Information
| Provider Information | |||||||||
| NPI: | 1770672099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATIVE ASSOCIATES INC | ||||||||
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| OtherOrganizationName: | REHAB ASSOCIATES - PICKERINGTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11177 LAMBS LN | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407630408 | ||||||||
| FaxNumber: | 7407630475 | ||||||||
| Practice Location | |||||||||
| Address1: | 384 COURTLAND LANE | ||||||||
| Address2: | PICKERINGTON RUN PLAZA | ||||||||
| City: | PICKERINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148378227 | ||||||||
| FaxNumber: | 6148379767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KONKLER | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7407630408 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2469529 | 05 | OH | MEDICAID |