Provider Demographics
NPI:1467575605
Name:VALLEY OUTPATIENT REHABILITATION SLP
Entity Type:Organization
Organization Name:VALLEY OUTPATIENT REHABILITATION SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-483-1673
Mailing Address - Street 1:1027 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1553
Mailing Address - Country:US
Mailing Address - Phone:724-258-6211
Mailing Address - Fax:724-258-6225
Practice Address - Street 1:1027 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1553
Practice Address - Country:US
Practice Address - Phone:724-258-6211
Practice Address - Fax:724-258-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherGROUP TAX ID
PA=========OtherGROUP TAX ID