Healthcare Provider Details

I. General information

NPI: 1609117761
Provider Name (Legal Business Name): REHAB ADVANTAGE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD UNIT 20
FAIRFIELD OH
45014-7206
US

IV. Provider business mailing address

1251 NILLES RD UNIT 20
FAIRFIELD OH
45014-7206
US

V. Phone/Fax

Practice location:
  • Phone: 513-341-8291
  • Fax: 513-341-5870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN CHIU
Title or Position: ADMINISTRATOR
Credential: P.T.
Phone: 513-341-8291