Provider Demographics
NPI:1699851493
Name:PREMIER REHABILITATION SYSTEMS, INC.
Entity Type:Organization
Organization Name:PREMIER REHABILITATION SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDBOM
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:724-379-6412
Mailing Address - Street 1:4660 STATE ROUTE 51
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4305
Mailing Address - Country:US
Mailing Address - Phone:724-379-6412
Mailing Address - Fax:412-592-0939
Practice Address - Street 1:1008 TAVERN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2801
Practice Address - Country:US
Practice Address - Phone:304-264-4040
Practice Address - Fax:304-264-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV600828800OtherDOL MARTINSBURG
WV001756986OtherMOUNTAIN STATE BC/BS
PA1568199OtherHIGHMARK BC/BS
VA600828801OtherDOL WINCHESTER
WV0207724000OtherWEST VIRGINIA MEDICAID
PA600828802OtherDOL MCMURRAY
WV600828803OtherDOL MORGANTOWN