Healthcare Provider Details

I. General information

NPI: 1760493399
Provider Name (Legal Business Name): NORTH CENTRAL REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 S DIXON RD SUITE 250
KOKOMO IN
46902-6401
US

IV. Provider business mailing address

2312 S DIXON RD SUITE 250
KOKOMO IN
46902-6401
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-2122
  • Fax: 765-455-3122
Mailing address:
  • Phone: 765-455-2122
  • Fax: 765-455-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CINDY J HOPWOOD
Title or Position: ADMINISTRATOR
Credential:
Phone: 765-455-2122