Provider Demographics
NPI:1093872376
Name:SYLVANIA ORTHOPAEDICS AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:SYLVANIA ORTHOPAEDICS AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-824-0300
Mailing Address - Street 1:5750 ALEXIS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2349
Mailing Address - Country:US
Mailing Address - Phone:419-824-0300
Mailing Address - Fax:419-824-0500
Practice Address - Street 1:5750 ALEXIS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2349
Practice Address - Country:US
Practice Address - Phone:419-824-0300
Practice Address - Fax:419-824-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X, 225100000X
OH36002275213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2848637Medicaid
OHSY9348811Medicare PIN