Provider Demographics
NPI:1164540258
Name:PENN REHAB NETWORK, INC
Entity Type:Organization
Organization Name:PENN REHAB NETWORK, INC
Other - Org Name:AQUATICS & REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PT, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-438-4001
Mailing Address - Street 1:1023 PITTSBURGH RD
Mailing Address - Street 2:MOUNTAIN VIEW PLAZA
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8407
Mailing Address - Country:US
Mailing Address - Phone:724-438-4001
Mailing Address - Fax:
Practice Address - Street 1:1023 PITTSBURGH RD
Practice Address - Street 2:MOUNTAIN VIEW PLAZA
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8407
Practice Address - Country:US
Practice Address - Phone:724-438-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN REHAB NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000657E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA858863OtherHIGHMARK
PA858863OtherHIGHMARK