MEDICARE: REHABPRO HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner	05008247A	IN

General Provider Information

NPI Number	:	1013216894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABPRO HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	324 FOX ORCHARD RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6577
Country	:	US
Telephone Number	:	260-580-1350
Fax Number	:	260-490-7690

Provider Business Practice Location Address
First Line	:	324 FOX ORCHARD RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6577
Country	:	US
Telephone Number	:	260-580-1350
Fax Number	:	260-490-7690

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TERENCE PADRIQUE
Credential	:	PT
Telephone Number	:	260-580-1350

Provider Enumeration Date	:	03/20/2011
Last Update Date	:	03/20/2011

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