Provider Demographics
NPI:1619291499
Name:OBSIDIAN HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:OBSIDIAN HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CFCE, CSCS
Authorized Official - Phone:812-786-4394
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-0762
Mailing Address - Country:US
Mailing Address - Phone:812-786-4394
Mailing Address - Fax:812-725-1634
Practice Address - Street 1:130 HUNTER STATION WAY STE 201
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-8932
Practice Address - Country:US
Practice Address - Phone:812-786-4394
Practice Address - Fax:812-725-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy