Provider Demographics
NPI:1639175474
Name:REHABILITATION AQUATICS AND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:REHABILITATION AQUATICS AND PHYSICAL THERAPY, INC.
Other - Org Name:CENTRAL PARK WEST REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RKT
Authorized Official - Phone:419-841-9622
Mailing Address - Street 1:3130 CENTRAL PARK W
Mailing Address - Street 2:STE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1088
Mailing Address - Country:US
Mailing Address - Phone:419-841-9622
Mailing Address - Fax:419-843-8288
Practice Address - Street 1:3130 CENTRAL PARK W
Practice Address - Street 2:STE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1088
Practice Address - Country:US
Practice Address - Phone:419-841-9622
Practice Address - Fax:419-843-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03396225100000X
OH01872225X00000X
OH03101225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0742647Medicaid
OH366573Medicare ID - Type UnspecifiedOUTPATIENT REHABILITATION