Provider Demographics
NPI:1568400919
Name:COMPREHENSIVE REHABILITATION GROUP INC
Entity Type:Organization
Organization Name:COMPREHENSIVE REHABILITATION GROUP INC
Other - Org Name:THE SPINE CARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-531-3003
Mailing Address - Street 1:1675 LANCE POINTE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-891-9800
Mailing Address - Fax:419-891-0989
Practice Address - Street 1:4035 W CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-531-3003
Practice Address - Fax:419-531-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2422131Medicaid
OH366679Medicare ID - Type UnspecifiedMEDICARE