Provider Demographics
NPI:1205042298
Name:REHABILITATION MANAGEMENT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:REHABILITATION MANAGEMENT SPECIALISTS, LLC
Other - Org Name:ACTIVE LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNIELL
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP, DACRB, CIRS
Authorized Official - Phone:610-349-6679
Mailing Address - Street 1:2207 VALLEY VIEW DR S
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8361
Mailing Address - Country:US
Mailing Address - Phone:610-349-6679
Mailing Address - Fax:
Practice Address - Street 1:2207 VALLEY VIEW DR S
Practice Address - Street 2:
Practice Address - City:SAYLORSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353
Practice Address - Country:US
Practice Address - Phone:610-349-6679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006207-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1445656OtherBSBC
PA0007957156OtherAETNA
PA01877901OtherASHN
PA3000378OtherKHPC
PA506314OtherAMERIHEALTH ADMIN.
PA0265170000OtherKHPE
PA01877901OtherASHN
PA3000378OtherKHPC