Provider Demographics
NPI:1083663595
Name:DIGITAL REHABILITATION ASSOCIATES INC
Entity Type:Organization
Organization Name:DIGITAL REHABILITATION ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TESLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:724-537-9588
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-0857
Mailing Address - Country:US
Mailing Address - Phone:724-537-9588
Mailing Address - Fax:
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:SUITE 003
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-537-9588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA755608OtherHIGHMARK GROUP NUMBER
PA755608OtherHIGHMARK GROUP NUMBER