Provider Demographics
NPI:1700093192
Name:TAYLOR REHABILITATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TAYLOR REHABILITATION ASSOCIATES, LLC
Other - Org Name:TOTAL BODY REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-882-1841
Mailing Address - Street 1:7733 NORTH BR
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9376
Mailing Address - Country:US
Mailing Address - Phone:419-882-1841
Mailing Address - Fax:419-882-1848
Practice Address - Street 1:5750 ALEXIS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2349
Practice Address - Country:US
Practice Address - Phone:419-882-1841
Practice Address - Fax:419-882-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2445278Medicaid
9345282OtherMEDICARE PTAN