Provider Demographics
NPI:1073630927
Name:PEDIATRIC SPECIALTY REHAB, INC.
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MERK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-945-2453
Mailing Address - Street 1:727 MOUNT TABOR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6951
Mailing Address - Country:US
Mailing Address - Phone:812-945-2453
Mailing Address - Fax:812-945-2453
Practice Address - Street 1:727 MOUNT TABOR RD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6951
Practice Address - Country:US
Practice Address - Phone:812-945-2453
Practice Address - Fax:812-945-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002026A225100000X
KY001184225100000X
IN06001709225200000X
KYA00698225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000283358Medicare UPIN
IN000000283356Medicare UPIN