Provider Demographics
NPI:1073897831
Name:UNITED REHAB SPECIALIST LLC
Entity Type:Organization
Organization Name:UNITED REHAB SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-782-1971
Mailing Address - Street 1:3098 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1432
Mailing Address - Country:US
Mailing Address - Phone:336-782-1971
Mailing Address - Fax:336-602-1951
Practice Address - Street 1:3098 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1432
Practice Address - Country:US
Practice Address - Phone:336-782-1971
Practice Address - Fax:336-602-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCP7421261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty