Provider Demographics
NPI:1548411986
Name:CONSULTATIVE PHYSICAL MEDICINE & REHABILITATION
Entity Type:Organization
Organization Name:CONSULTATIVE PHYSICAL MEDICINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-594-7310
Mailing Address - Street 1:1641 N MEMORIAL DR # 121
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1632
Mailing Address - Country:US
Mailing Address - Phone:740-594-7310
Mailing Address - Fax:
Practice Address - Street 1:HICKORY CREEK OF ATHENS
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780
Practice Address - Country:US
Practice Address - Phone:740-797-4561
Practice Address - Fax:740-797-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008368314000000X
VA0102202192314000000X
NJ25MB05670800314000000X
NY176034314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE95742Medicare UPIN