Provider Demographics
NPI:1790899862
Name:APPALACHIAN REHAB SERVICE/APPALACHIAN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:APPALACHIAN REHAB SERVICE/APPALACHIAN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MENSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:570-323-0717
Mailing Address - Street 1:1900 RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1799
Mailing Address - Country:US
Mailing Address - Phone:570-323-0717
Mailing Address - Fax:570-323-3312
Practice Address - Street 1:1900 RAVINE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1799
Practice Address - Country:US
Practice Address - Phone:570-323-0717
Practice Address - Fax:570-323-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003201-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty