Provider Demographics
NPI:1649222886
Name:PREMIER REHAB, LLC
Entity Type:Organization
Organization Name:PREMIER REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:513-821-8700
Mailing Address - Street 1:7922 WINDING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6910
Mailing Address - Country:US
Mailing Address - Phone:513-821-8700
Mailing Address - Fax:513-821-0500
Practice Address - Street 1:7922 WINDING CREEK CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6910
Practice Address - Country:US
Practice Address - Phone:513-821-8700
Practice Address - Fax:513-821-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 005428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty