Provider Demographics
NPI:1164990248
Name:REHAB PARTNERS OF FORT PAYNE
Entity Type:Organization
Organization Name:REHAB PARTNERS OF FORT PAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:IBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-997-9006
Mailing Address - Street 1:121 DRINKARD DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3758
Mailing Address - Country:US
Mailing Address - Phone:256-997-9006
Mailing Address - Fax:
Practice Address - Street 1:121 DRINKARD DR NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3758
Practice Address - Country:US
Practice Address - Phone:256-997-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty