UNIVERSITY REHABILITATION, INC.

Provider Demographics

• NPI: 1235197302
• Name: UNIVERSITY REHABILITATION, INC.
• Entity Type: Organization
• Organization Name: UNIVERSITY REHABILITATION, INC.
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: MARK
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: GODDARD
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 513-558-2919
• Mailing Address - Street 1: 2830 VICTORY PKWY
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45206-1785
• Mailing Address - Country: US
• Mailing Address - Phone: 513-245-3617
• Mailing Address - Fax: 513-475-7259
• Practice Address - Street 1: 151 W GALBRAITH RD
• Practice Address - Street 2: DRAKE CENTER
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45216-1015
• Practice Address - Country: US
• Practice Address - Phone: 513-418-2707
• Practice Address - Fax: 513-418-5838
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-01
• Last Update Date: 2010-09-24

Provider Licenses

State	License ID	Taxonomies
		208100000X, 2084N0400X
OH	50.000932	363A00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Single Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Single Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	2529580	Medicaid
OH	2331015	Medicaid
OH	2529393	Medicaid
OH	2548121	Medicaid
OH	2609672	Medicaid
KY	65912933	Medicaid
OH	0626175	Medicaid
IN	100011480	Medicaid
OH	2529437	Medicaid
KY	50005942	Other	PASSPORT HEALTH PLAN
OH	2330972	Medicaid
OH	2330981	Medicaid
OH	2330990	Medicaid
	=========	Other	HUMANA
IN	100011480	Medicaid
OH	2330972	Medicaid
OH	2529437	Medicaid