Provider Demographics
NPI:1114962974
Name:REHAB PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:REHAB PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:440-580-0088
Mailing Address - Street 1:3570 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 102-D
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5288
Mailing Address - Country:US
Mailing Address - Phone:440-580-0088
Mailing Address - Fax:440-580-0088
Practice Address - Street 1:3570 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 102-D
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5288
Practice Address - Country:US
Practice Address - Phone:440-580-0088
Practice Address - Fax:440-580-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRE9336111Medicare ID - Type Unspecified