Provider Demographics
NPI:1659711737
Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIANNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:724-343-4060
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1294 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1212
Practice Address - Country:US
Practice Address - Phone:814-297-8093
Practice Address - Fax:814-297-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101954133001Medicaid
PA396749Medicare PIN