Provider Demographics
NPI:1184714594
Name:BETHEL REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:BETHEL REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENEDICTA
Authorized Official - Middle Name:BOSEDE
Authorized Official - Last Name:OHIANI-JEGEDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-980-2774
Mailing Address - Street 1:3111 W 60TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2226
Mailing Address - Country:US
Mailing Address - Phone:219-980-2774
Mailing Address - Fax:219-980-2779
Practice Address - Street 1:3111 W 60TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2226
Practice Address - Country:US
Practice Address - Phone:219-980-2774
Practice Address - Fax:219-980-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005347A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty