Provider Demographics
NPI:1275514564
Name:SAINT VINCENT REHAB SOLUTIONS LLC
Entity Type:Organization
Organization Name:SAINT VINCENT REHAB SOLUTIONS LLC
Other - Org Name:SAINT VINCENT REHAB SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-5772
Mailing Address - Street 1:153 E 13TH ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1035
Mailing Address - Country:US
Mailing Address - Phone:814-860-5000
Mailing Address - Fax:814-860-5050
Practice Address - Street 1:4247 W RIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1746
Practice Address - Country:US
Practice Address - Phone:814-338-7249
Practice Address - Fax:814-838-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
067399Medicare PIN