Provider Demographics
NPI:1013216894
Name:REHABPRO HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:REHABPRO HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:260-580-1350
Mailing Address - Street 1:324 FOX ORCHARD RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6577
Mailing Address - Country:US
Mailing Address - Phone:260-580-1350
Mailing Address - Fax:260-490-7690
Practice Address - Street 1:324 FOX ORCHARD RUN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6577
Practice Address - Country:US
Practice Address - Phone:260-580-1350
Practice Address - Fax:260-490-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008247A225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty