Provider Demographics
NPI:1144418138
Name:CAIRO REHAB & FIT FORE GOLF INC
Entity Type:Organization
Organization Name:CAIRO REHAB & FIT FORE GOLF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-363-7000
Mailing Address - Street 1:120 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:IL
Mailing Address - Zip Code:62964-1022
Mailing Address - Country:US
Mailing Address - Phone:304-363-7000
Mailing Address - Fax:304-366-7413
Practice Address - Street 1:120 N FRONT ST
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:IL
Practice Address - Zip Code:62964-1022
Practice Address - Country:US
Practice Address - Phone:304-363-7000
Practice Address - Fax:304-366-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2016-01-12
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
IL211197Medicare PIN