Provider Demographics
NPI:1326411729
Name:IRONTON PHYSICAL MEDICINE AND REHAB LLC
Entity Type:Organization
Organization Name:IRONTON PHYSICAL MEDICINE AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-532-8888
Mailing Address - Street 1:901 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1529
Mailing Address - Country:US
Mailing Address - Phone:740-532-8888
Mailing Address - Fax:740-532-1796
Practice Address - Street 1:901 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1529
Practice Address - Country:US
Practice Address - Phone:740-532-8888
Practice Address - Fax:740-532-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty