Provider Demographics
NPI:1033487780
Name:MEDICAL TECHNICAL REHABILITATION LLC
Entity Type:Organization
Organization Name:MEDICAL TECHNICAL REHABILITATION LLC
Other - Org Name:MEDTECH REHAB BLAIRSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-834-1144
Mailing Address - Street 1:1984 ROUTE 22 HWY W
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1264
Mailing Address - Country:US
Mailing Address - Phone:724-459-4884
Mailing Address - Fax:724-459-4886
Practice Address - Street 1:1984 ROUTE 22 HWY W
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1264
Practice Address - Country:US
Practice Address - Phone:724-459-4884
Practice Address - Fax:724-459-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA327022261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAPPLYINGMedicaid