Provider Demographics
NPI:1114907862
Name:THERACARE INC
Entity Type:Organization
Organization Name:THERACARE INC
Other - Org Name:THERACARE PHYSICLA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT MG
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:RENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-965-0016
Mailing Address - Street 1:1219 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1940
Mailing Address - Country:US
Mailing Address - Phone:937-322-8151
Mailing Address - Fax:937-322-8157
Practice Address - Street 1:1219 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1940
Practice Address - Country:US
Practice Address - Phone:937-322-8151
Practice Address - Fax:937-322-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2133551Medicaid
OH=========01OtherBWE
OH=========01OtherBWE