Healthcare Provider Details

I. General information

NPI: 1235197302
Provider Name (Legal Business Name): UNIVERSITY REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W GALBRAITH RD DRAKE CENTER
CINCINNATI OH
45216-1015
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-418-2707
  • Fax: 513-418-5838
Mailing address:
  • Phone: 513-245-3617
  • Fax: 513-475-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.000932
License Number StateOH

VIII. Authorized Official

Name: DR. MARK J. GODDARD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-558-2919