MEDICARE: FULL RANGE REHAB LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104987684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL RANGE REHAB LLC

Provider Business Mailing Address
First Line	:	9010 GOLDPARK DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-9764
Country	:	US
Telephone Number	:	513-330-5995
Fax Number	:	800-819-7985

Provider Business Practice Location Address
First Line	:	9010 GOLDPARK DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-9764
Country	:	US
Telephone Number	:	513-330-5995
Fax Number	:	800-819-7985

Authorized Official
Title or Position	:	QUALITY AND COMPLIANCE MANAGER
Name	:	BARBARA RIVERS
Credential	:
Telephone Number	:	513-330-5995

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/23/2019

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Directions to “FULL RANGE REHAB LLC ” Practice Location

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