Healthcare Provider Details

I. General information

NPI: 1588787154
Provider Name (Legal Business Name): MIDWEST REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E HIGHLAND AVE
ADA OH
45810-1120
US

IV. Provider business mailing address

118 E HIGHLAND AVE
ADA OH
45810-1120
US

V. Phone/Fax

Practice location:
  • Phone: 419-634-8655
  • Fax: 419-634-0402
Mailing address:
  • Phone: 419-634-8655
  • Fax: 419-634-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number0947239
License Number StateOH

VIII. Authorized Official

Name: MR. STEPHEN P ZUBER
Title or Position: PRESIDENT
Credential:
Phone: 419-634-8655