Provider Demographics
NPI:1235599770
Name:RELIANT REHAB
Entity Type:Organization
Organization Name:RELIANT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:605-321-9737
Mailing Address - Street 1:25995 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDIER
Mailing Address - State:IA
Mailing Address - Zip Code:51572-4070
Mailing Address - Country:US
Mailing Address - Phone:712-884-2386
Mailing Address - Fax:
Practice Address - Street 1:25995 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOLDIER
Practice Address - State:IA
Practice Address - Zip Code:51572-4070
Practice Address - Country:US
Practice Address - Phone:712-884-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000181314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility