Provider Demographics
NPI:1528365913
Name:MOHICAN REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:MOHICAN REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TIELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:740-392-8811
Mailing Address - Street 1:112 HARCOURT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3946
Mailing Address - Country:US
Mailing Address - Phone:740-392-8811
Mailing Address - Fax:740-392-6485
Practice Address - Street 1:112 HARCOURT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3946
Practice Address - Country:US
Practice Address - Phone:740-392-8811
Practice Address - Fax:740-392-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty