Provider Demographics
NPI:1407102023
Name:KEYSTONE REHABILITATION SYSTEMS, INC.
Entity Type:Organization
Organization Name:KEYSTONE REHABILITATION SYSTEMS, INC.
Other - Org Name:KEYSTONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:FLECK
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-467-8705
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-5245
Mailing Address - Country:US
Mailing Address - Phone:724-465-3496
Mailing Address - Fax:215-413-4682
Practice Address - Street 1:51520 NATIONAL RD E
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8213
Practice Address - Country:US
Practice Address - Phone:740-695-5662
Practice Address - Fax:740-695-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366571Medicare Oscar/Certification