Healthcare Provider Details

I. General information

NPI: 1245290063
Provider Name (Legal Business Name): EAGLE REHAB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date: 10/29/2007
Reactivation Date: 12/13/2007

III. Provider practice location address

15918 19 MILE RD STE 150
CLINTON TOWNSHIP MI
48038
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-0240
  • Fax: 586-228-0182
Mailing address:
  • Phone: 717-972-1100
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100