Provider Demographics
NPI:1164634820
Name:THERAPEUTIC REHAB SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/OT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:423-310-0555
Mailing Address - Street 1:500 LEBANON VALLEY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-8477
Mailing Address - Country:US
Mailing Address - Phone:423-310-0555
Mailing Address - Fax:423-479-4421
Practice Address - Street 1:500 LEBANON VALLEY CHURCH RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-8477
Practice Address - Country:US
Practice Address - Phone:423-310-0555
Practice Address - Fax:423-479-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514708Medicaid
TN1514708Medicaid