MEDICARE: PHYSICIANS DIAGNOSTIC & REHABILITATION CENTER INC

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	111N00000X	Chiropractor	2426	OH
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	34.002093	OH
3	111N00000X	Chiropractor	2533	OH

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	:	1417058009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS DIAGNOSTIC & REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	914 TRAILWOOD DR
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5007
Country	:	US
Telephone Number	:	330-758-6440
Fax Number	:	330-758-6990

Provider Business Practice Location Address
First Line	:	914 TRAILWOOD DR
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5007
Country	:	US
Telephone Number	:	330-758-6440
Fax Number	:	330-758-6990

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARIA IGNAZIO
Credential	:
Telephone Number	:	330-758-6440

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/26/2012

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Directions to “PHYSICIANS DIAGNOSTIC & REHABILITATION CENTER INC ” Practice Location

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