Provider Demographics
NPI:1780763763
Name:ADVANCED REHABILITATION AND HEALTH SPECIALISTS INC
Entity type:Organization
Organization Name:ADVANCED REHABILITATION AND HEALTH SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:KNOWLTON
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-274-2747
Mailing Address - Street 1:4707 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-8934
Mailing Address - Country:US
Mailing Address - Phone:330-274-2747
Mailing Address - Fax:330-274-0337
Practice Address - Street 1:4707 MILL STREET
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255
Practice Address - Country:US
Practice Address - Phone:330-274-2747
Practice Address - Fax:330-274-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161922Medicaid
OH2161922Medicaid
OH5099370001Medicare NSC