Provider Demographics
NPI:1356526958
Name:REHAB AT HOME PLLC
Entity type:Organization
Organization Name:REHAB AT HOME PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:253-226-3303
Mailing Address - Street 1:417 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3267
Mailing Address - Country:US
Mailing Address - Phone:253-604-4824
Mailing Address - Fax:253-604-4826
Practice Address - Street 1:417 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3267
Practice Address - Country:US
Practice Address - Phone:253-604-4824
Practice Address - Fax:253-604-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA712402Medicaid
WA8801802OtherMEDICARE ID - PARTICIPATING PRACTIONER
WA712402Medicaid