Provider Demographics
NPI:1659567113
Name:RE HAB PROFESSIONALS OF CLEVELAND,INC.
Entity Type:Organization
Organization Name:RE HAB PROFESSIONALS OF CLEVELAND,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUBE'
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:440-526-8566
Mailing Address - Street 1:7000 TOWN CENTRE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4008
Mailing Address - Country:US
Mailing Address - Phone:440-536-8566
Mailing Address - Fax:440-546-8280
Practice Address - Street 1:12221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5029
Practice Address - Country:US
Practice Address - Phone:216-221-2525
Practice Address - Fax:216-221-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2172321Medicaid
OH=========03OtherOHIO WORKERS COMP
OH9289204Medicare PIN