Provider Demographics
NPI:1932677853
Name:REHABILITATION & PHYSICAL MEDICINE CLINIC LLC
Entity Type:Organization
Organization Name:REHABILITATION & PHYSICAL MEDICINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-224-8007
Mailing Address - Street 1:750 W HIGH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3995
Mailing Address - Country:US
Mailing Address - Phone:419-224-8007
Mailing Address - Fax:419-516-4881
Practice Address - Street 1:750 W HIGH ST STE 200
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3995
Practice Address - Country:US
Practice Address - Phone:419-224-8007
Practice Address - Fax:419-516-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty