Provider Demographics
NPI:1669446944
Name:CENTER FOR BALANCE RELATED DISORDERS AND REHABILITATION INC
Entity Type:Organization
Organization Name:CENTER FOR BALANCE RELATED DISORDERS AND REHABILITATION INC
Other - Org Name:CENTER FOR BALANCE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHUMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:513-891-0934
Mailing Address - Street 1:PO BOX 30155
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-0155
Mailing Address - Country:US
Mailing Address - Phone:513-891-0934
Mailing Address - Fax:513-891-1323
Practice Address - Street 1:10791 MONTGOMERY RD.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-891-0934
Practice Address - Fax:513-891-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2376549Medicaid
OHCE9330611Medicare PIN