Healthcare Provider Details

I. General information

NPI: 1073989703
Provider Name (Legal Business Name): REHABON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BURNT BRIDGE RD
SHARON MA
02067-2991
US

IV. Provider business mailing address

80 BRIDGE ST 207
DEDHAM MA
02026-1765
US

V. Phone/Fax

Practice location:
  • Phone: 312-730-4593
  • Fax:
Mailing address:
  • Phone: 312-730-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number19060
License Number StateMA

VIII. Authorized Official

Name: IRFAN MEHMUD IBRAHIM
Title or Position: OWNER & CEO
Credential: PT
Phone: 312-730-4593