Provider Demographics
NPI:1366881005
Name:REHAB SPECIALISTS, LLC
Entity type:Organization
Organization Name:REHAB SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FATE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT,MBA
Authorized Official - Phone:269-760-1437
Mailing Address - Street 1:5717 OAKLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1116
Mailing Address - Country:US
Mailing Address - Phone:269-978-2490
Mailing Address - Fax:888-334-7087
Practice Address - Street 1:5717 OAKLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1116
Practice Address - Country:US
Practice Address - Phone:269-978-2490
Practice Address - Fax:888-334-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty