Provider Demographics
NPI:1447200993
Name:INDEPENDENCE REHAB, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE REHAB, INC.
Other - Org Name:INDEPENDENCE SPORTS MEDICINE & SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOGLIATTI-TRICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-845-5055
Mailing Address - Street 1:PO BOX 31174
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-0174
Mailing Address - Country:US
Mailing Address - Phone:440-845-5055
Mailing Address - Fax:440-845-5054
Practice Address - Street 1:7900 VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4891
Practice Address - Country:US
Practice Address - Phone:440-845-5055
Practice Address - Fax:440-845-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
OH35.072965208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2361260Medicaid
OH4828270001Medicare NSC
OH9325931Medicare UPIN