Provider Demographics
NPI:1548234339
Name:DEFIANCE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:DEFIANCE REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT ATC
Authorized Official - Phone:419-782-8808
Mailing Address - Street 1:851 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2770
Mailing Address - Country:US
Mailing Address - Phone:419-782-8808
Mailing Address - Fax:419-782-8148
Practice Address - Street 1:851 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2770
Practice Address - Country:US
Practice Address - Phone:419-782-8808
Practice Address - Fax:419-782-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7200261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy