Provider Demographics
NPI:1467549857
Name:LICKING REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:LICKING REHABILITATION SERVICES INC
Other - Org Name:REHAB ASSOCIATES - NEWARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:C
Authorized Official - Last Name:KONKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-760-0408
Mailing Address - Street 1:1220 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1040
Mailing Address - Country:US
Mailing Address - Phone:740-345-2837
Mailing Address - Fax:740-763-0475
Practice Address - Street 1:1220 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1040
Practice Address - Country:US
Practice Address - Phone:740-345-2837
Practice Address - Fax:740-763-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2469510Medicaid
OH9282162Medicare PIN