Provider Demographics
NPI:1831547942
Name:REHABILITATION SPECIALISTS OF SOUTHWEST OHIO
Entity type:Organization
Organization Name:REHABILITATION SPECIALISTS OF SOUTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAGNUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-435-3620
Mailing Address - Street 1:25 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8301
Mailing Address - Country:US
Mailing Address - Phone:937-212-4098
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-435-3620
Practice Address - Fax:937-435-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170008Medicaid
OHDW7230Medicare PIN
OH0170008Medicaid