Basic Information
| Provider Information | |||||||||
| NPI: | 1902976855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB1,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 613 CRICKLEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193828507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103991544 | ||||||||
| FaxNumber: | 4842660409 | ||||||||
| Practice Location | |||||||||
| Address1: | 613 CRICKLEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193828507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103991544 | ||||||||
| FaxNumber: | 4842660409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 04/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6103991544 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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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 |
No ID Information.