Provider Demographics
NPI:1407859309
Name:PROHAB PHYSICAL THERAPY EAST, LLC
Entity Type:Organization
Organization Name:PROHAB PHYSICAL THERAPY EAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCHEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-698-2500
Mailing Address - Street 1:4725 WOODVILLE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4725 WOODVILLE RD
Practice Address - Street 2:STE 4
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1857
Practice Address - Country:US
Practice Address - Phone:419-698-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2616771Medicaid
OH2616771Medicaid