Healthcare Provider Details

I. General information

NPI: 1548772973
Provider Name (Legal Business Name): FORT WAYNE SEATING & REHAB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 THUNDER HILL PL
FORT WAYNE IN
46804-4825
US

IV. Provider business mailing address

9315 THUNDER HILL PL
FORT WAYNE IN
46804-4825
US

V. Phone/Fax

Practice location:
  • Phone: 260-420-0332
  • Fax:
Mailing address:
  • Phone: 260-420-0332
  • Fax: 260-420-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005736A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA MICHAEL OESTERLING
Title or Position: CEO
Credential: OTR/L, ATP
Phone: 812-560-9173