Healthcare Provider Details

I. General information

NPI: 1821634650
Provider Name (Legal Business Name): BH REHAB AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 PINE RD STE 100
CINCINNATI OH
45236-2192
US

IV. Provider business mailing address

5743 RUTLEDGE TRL
LIBERTY TWP OH
45011-1245
US

V. Phone/Fax

Practice location:
  • Phone: 513-519-7021
  • Fax: 513-299-0542
Mailing address:
  • Phone: 513-519-7021
  • Fax: 513-299-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHAEL HANCOCK
Title or Position: MEMBER
Credential: DC
Phone: 513-519-7021