Provider Demographics
NPI:1801308986
Name:PHYSICAL REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:PHYSICAL REHABILITATION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:740-424-9157
Mailing Address - Street 1:860 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3870
Mailing Address - Country:US
Mailing Address - Phone:740-264-9500
Mailing Address - Fax:740-266-6394
Practice Address - Street 1:860 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3870
Practice Address - Country:US
Practice Address - Phone:740-264-9500
Practice Address - Fax:740-266-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260052Medicaid