Healthcare Provider Details

I. General information

NPI: 1114903234
Provider Name (Legal Business Name): REHAB UNLIMITED AT SOUTHBRIDGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD SUITE A-1
BOARDMAN OH
44512-4380
US

IV. Provider business mailing address

725 BOARDMAN CANFIELD RD SUITE A-1
BOARDMAN OH
44512-4380
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-0151
  • Fax: 330-726-6540
Mailing address:
  • Phone: 330-726-0151
  • Fax: 330-726-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number36-6707
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS P. YANKUSH
Title or Position: OWNER
Credential: D.C.
Phone: 330-726-0151