Provider Demographics
NPI:1124028758
Name:GASTON REHAB ASSOCIATES, INC
Entity Type:Organization
Organization Name:GASTON REHAB ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-864-4424
Mailing Address - Street 1:1385 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5127
Mailing Address - Country:US
Mailing Address - Phone:704-864-4424
Mailing Address - Fax:704-864-2125
Practice Address - Street 1:1385 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5127
Practice Address - Country:US
Practice Address - Phone:704-864-4424
Practice Address - Fax:704-864-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8975261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3484600OtherAETNA HMO
NC7211587Medicaid
NCD3291OtherMEDCOST
NC078V2OtherBLUE CROSS BLUE SHIELD
NC7559538OtherAETNA PPO/POS
NC2505167Medicare ID - Type Unspecified