Provider Demographics
NPI:1659454908
Name:MEDICAL DIAGNOSTICS AND REHABILITATION LLC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTICS AND REHABILITATION LLC
Other - Org Name:THE MVA CENTER FOR REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO MANAGER OF THE LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLIONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-734-8440
Mailing Address - Street 1:300 STAFFORD STREET
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-734-8440
Mailing Address - Fax:413-731-6703
Practice Address - Street 1:300 STAFFORD STREET
Practice Address - Street 2:SUITE 360
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-734-8440
Practice Address - Fax:413-731-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty