Provider Demographics
NPI:1700873809
Name:KETTERING REHABILITATION, INC
Entity Type:Organization
Organization Name:KETTERING REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUNLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-384-8797
Mailing Address - Street 1:PO BOX 750245
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-0245
Mailing Address - Country:US
Mailing Address - Phone:937-438-9500
Mailing Address - Fax:937-438-9075
Practice Address - Street 1:2150 LEITER RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3660
Practice Address - Country:US
Practice Address - Phone:937-384-8797
Practice Address - Fax:937-384-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042424B208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA80616Medicare UPIN